Background and Importance Our health facility conducts approximately 400 annual carpal tunnel (CT) surgeries using three distinct ambulatory methods: (1) ultrasound-guided in the operating room (OR), (2) ultrasound-guided office surgery in the consultation room, and (3) endoscopy-assisted in the OR.

Aim and Objectives The study’s objective was to assess the environmental footprint of each care pathway and to eco-design the care pathway with the lowest possible impact.

Material and Methods A mixed multidisciplinary team (pharmacist, surgeon, sustainable development engineer) was established. The pharmacist was defined as the pilot of the study. Three life cycle assessments (LCA) were conducted using SimaPro software. The functional unit was ‘Performing an outpatient CT surgery, from planning to post-op care’. Ten impact categories were considered including for example global warming (kg CO2e), terrestrial; freshwater and marine ecotoxicity (kg 1.4-DCB), assuming equal patient-to-health-facility distance and surgical efficiency.

Results Care pathway (2) has a 20 kg CO2e carbon footprint, which is half of (1) at 43 kg CO2e, and a third of (3) at 75 kg CO2e. The most significant impacts are patient transport and electricity: for (2) 74% from patient transport and 1% from electricity; for (1) 26% from patient transport and 54% from electricity; for (3) 40% from patient transport and 36% from electricity. Healthcare products (HP) represent an average of 25% of the total impact. The stages with the highest HP impacts were: draping and sterile dressing (0.28kg CO2e (2), 2.7kg CO2e (1) and 6.7kg CO2e (3)); skin preparation of the operating area (0.5kg CO2e (2), 0.9kg CO2e (1) and (3)); and anaesthesia (0.3kg CO2e (1) and (2), 1kg CO2e (3)). In anaesthesia, drugs (acetaminophen, lidocaine, mepivacaine) had minimal impact (10%), whereas for skin preparation, drugs (alcoholic betadine) had a greater impact (70% to 100%) than sterile medical devices. Modelling the implementation of teleconsultation showed a potential savings of 6kg CO2e for (1) and (2) and 12kg CO2e for (3).

Conclusion and Relevance Office surgery, with its minimal impact and equivalent clinical effectiveness, should be promoted. Further reducing its environmental footprint requires essential steps, such as promoting teleconsultation. Pharmacists can also make a significant impact by optimising HP utilisation (e.g., right-sized drapes, no reinforced gowns for non-invasive procedures, controlled betadine use, efficient neurostimulation needle cable recycling).

Conflict of Interest No conflict of interest.