Potential Carbon Savings with Day-case Compared to Inpatient Transurethral Resection of Bladder Tumour Surgery in England: A Retrospective Observational Study Using Administrative Data

Manraj Phull; Hasina Begum; Joseph B John; Maria van Hove; John McGrath; Kieran O'Flynn; Tim W R Briggs; William K Gray

doi:10.1016/j.euros.2023.03.007

Potential Carbon Savings with Day-case Compared to Inpatient Transurethral Resection of Bladder Tumour Surgery in England: A Retrospective Observational Study Using Administrative Data

Eur Urol Open Sci. 2023 Apr 30:52:44-50. doi: 10.1016/j.euros.2023.03.007. eCollection 2023 Jun.

Authors

Manraj Phull¹, Hasina Begum², Joseph B John^{3

4}, Maria van Hove^{3

5}, John McGrath^{3

4}, Kieran O'Flynn^{3

6}, Tim W R Briggs^{3

7}, William K Gray³

Affiliations

¹ Urology Department, West Hertfordshire Hospitals NHS Trust, Watford, UK.
² Greener NHS National Programme, NHS England, London, UK.
³ Getting It Right First Time Programme, NHS England, London, UK.
⁴ Department of Urology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK.
⁵ Department of Public Health and Sport Sciences, University of Exeter, Exeter, UK.
⁶ Department of Urology, Salford Royal, Northern Care Alliance NHS Foundation Trust, Salford, UK.
⁷ Department of Surgery, Royal National Orthopaedic Hospital, Stanmore, UK.

Abstract

Background: The National Health Service (NHS) in England has set a net-zero target for carbon emissions by 2040. Increasing use of day-case surgery pathways may help in meeting this target.

Objective: To investigate the estimated difference in carbon footprint between day-case and inpatient transurethral resection of bladder tumour (TURBT) surgery in England.

Design setting and participants: This was a retrospective analysis of administrative data extracted from the Hospital Episode Statistics database for all TURBT procedures conducted in England from April 1, 2013 to March 31, 2022.

Outcome measurements and statistical analysis: Day-case and inpatient TURBT procedures were identified and the carbon footprint for key elements of the surgical pathway was estimated using data from Greener NHS and the Sustainable Healthcare Coalition.

Results and limitations: Of 209 269 TURBT procedures identified, 41 583 (20%) were classified as day-case surgery. The day-case rate increased from 13% in 2013-2014 to 31% in 2021-2022. The move from inpatient stays to day-case surgery between 2013-2014 and 2021-2022 demonstrates a trend toward a lower-carbon pathway, with an estimated saving of 2.9 million kg CO₂ equivalents (equivalent to powering 2716 homes for 1 yr) in comparison to no change in practice. We calculated that potential carbon savings for the financial year 2021-2022 would be 217 599 kg CO₂ equivalents (equivalent to powering 198 homes for 1 yr) if all hospitals in England not already in the upper quartile were able to achieve the current upper-quartile day-case rate. Our study is limited in that estimates are based on carbon factors for generic surgical pathways.

Conclusions: Our study highlights potential NHS carbon savings that could be achieved by moving from inpatient stays to day-case surgery. Reducing variation in care across the NHS and encouraging all hospitals to adopt day-case surgeries, where clinically appropriate, would lead to further carbon savings.

Patient summary: In this study we estimated the potential for carbon savings if patient undergoing bladder tumour surgery were admitted and discharged on the same day. We estimate that increasing use of day-case surgery between 2013-2014 and 2021-2022 has saved 2.9 million kg CO₂ equivalents. If all hospitals were to achieve day case-rates comparable to those in the highest quarter of hospitals in England in 2021-2022, then the carbon equivalent to powering 198 homes for 1 year could have been saved.

Keywords: Carbon footprint; Day case; Sustainable health care; Transurethral resection of bladder tumour; Urology.