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Measuring and improving the cradle-to-grave environmental performance of urological procedures

Nature Reviews Urology (2024)Cite this article

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Abstract

An urgent need for societal transformation exists to reduce the environmental impact of humanity, because environmental health affects human health. Health care causes ~5% of global greenhouse gas emissions and other substantial and ongoing environmental harms. Thus, health-care professionals and managers must lead ongoing efforts to improve the environmental performance of health systems. Life-cycle assessment (LCA) is a methodology that enables estimation of environmental impacts of products and processes. It models environmental effects from ‘cradle’ (raw material extraction) to ‘grave’ (end of useful life) and conventionally reports a range of different impact categories. LCA is a valuable tool when used appropriately. Maximizing its utility requires rational assumptions alongside careful consideration of system boundaries and data sources. Well-executed LCAs are detailed and transparently reported, enabling findings to be adapted or generalized to different settings. Attention should be given to modelling mitigation solutions in LCAs. This important step can guide health-care systems towards new and innovative solutions that embed progress towards international climate agreements. Many urological conditions are common, recurrent or chronic, requiring resource-intensive management with large associated environmental impacts. LCAs in urology have predominantly focussed on greenhouse gas emissions and have enabled identification of modifiable ‘hotspots’ including electricity use, travel, single-use items, irrigation, reprocessing and waste incineration. However, the methodological and reporting quality of published urology LCAs generally requires improvement and standardization. Health-care evaluation and commissioning frameworks that value LCA findings alongside clinical outcomes and cost could accelerate sustainable innovations. Rapid implementation strategies for known environmentally sustainable solutions are also needed.

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Fig. 1: Life-cycle stages modelled in cradle-to-grave and cradle-to-gate assessments.
Fig. 2: Impact categories covered in the ReCiPe 2016 method.
Fig. 3: Per-use GHG emissions of reusable flexible ureteroscopes with different national and regional GHG electricity emission factors substituted to produce different estimates.
Fig. 4: Per-use greenhouse gas emissions attributable to manufacturing and repair of reusable ureteroscopes according to the number of lifetime uses.

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Authors and Affiliations

  1. University of Exeter Medical School, University of Exeter, Exeter, UK

    Joseph B. John

  2. Getting it Right First Time, NHS England, London, UK

    Joseph B. John, William K. Gray, Tim W. R. Briggs & John S. McGrath

  3. Department of Urology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK

    Joseph B. John

  4. Royal National Orthopaedic Hospital NHS Trust, London, UK

    Tim W. R. Briggs

  5. Bristol Medical School, University of Bristol, Bristol, UK

    John S. McGrath

  6. Department of Urology, North Bristol NHS Trust, Bristol, UK

    John S. McGrath

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Contributions

J.B.J. researched data for the article. J.B.J., W.K.G. and J.S.M. contributed substantially to discussion of the content. J.B.J. and W.K.G. wrote the article. All authors reviewed and/or edited the manuscript before submission.

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GIRFT: https://gettingitrightfirsttime.co.uk/what-we-do/

GIRFT academy resources: https://gettingitrightfirsttime.co.uk/academy-resources/

GIRFT all clinical metrics: https://model.nhs.uk/home

Greener NHS areas of focus: https://www.england.nhs.uk/greenernhs/a-net-zero-nhs/areas-of-focus/

Greener NHS net zero supplier roadmap: https://www.england.nhs.uk/greenernhs/get-involved/suppliers/

Sustainable Healthcare Coalition core pathway carbon calculator: https://shcoalition.org/care-pathway-carbon-calculator-2/

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John, J.B., Gray, W.K., Briggs, T.W.R. et al. Measuring and improving the cradle-to-grave environmental performance of urological procedures. Nat Rev Urol (2024). https://doi.org/10.1038/s41585-024-00937-0

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