If you start from the premise that humans are the vilest scourge ever to evolve on the face of the planet and must be eliminated, this all makes sense

stay still, damn it!

Cancer surgery causes global warming

…Agbafe and Berlin outline some answers. Their paper describes how surgery, particularly cancer surgery, contributes to climate change and suggests some solutions to combat the problem, from reducing waste to rethinking how surgical care is delivered.

“In general, these ideas are good for our planet,” Agbafe said. “But also, surgery unfortunately plays a disproportionate role in the carbon output and the waste we produce in medicine.”

Operating rooms are a massive source of greenhouse gas production for hospitals, representing 70% of their waste and generating three to six times as much carbon as the rest of health systems.

Cancer care is an obvious target for greener efforts within surgery, Berlin notes, because it often involves intense levels of care over a short period of time.

Plus, minimally invasive surgeries that require a lot of energy, including robotic-assisted operations, have become common treatments for cancers ranging from colorectal and uterine cancer to head and neck cancer. A robotic-assisted hysterectomy, for example, produces as much carbon as driving more than 2,200 miles in a car — the equivalent of a road trip from Ann Arbor, Mich., to Los Angeles….

So either you can have your children fly in from Los Angeles to say goodbye, or you can have your cancerous uterus removed: not both, you greedy thing.

What to do differently

One of the most feasible changes to make in this space would be around waste reduction, Agbafe said.

This might be as simple as making sure that anything thrown away before or during surgery is properly categorized and labeled since it’s estimated that over 90% of OR waste does not meet the necessary standards for the type of trash it ends up in. (The red waste bags in ORs are intended only for items that have been exposed to bodily fluids and are much more expensive to dispose of than clear disposal bags.)

And everyone knows that mislabelled trash has been killing poor polar bears for years — just ask Al.

The surgical supply chain could be more efficient, too, they write. Estimates suggest that 87% of the surgical instruments laid out for an operation are rarely used, so coming up with standardized lists of the necessary tools for surgeries that occur regularly could cut down on cost, waste and the energy needed to sterilize and repackage those instruments.

And if one of the missing surgical instruments does turn out to be suddenly neceassy? Well, at least the patient will die knowing that he helped save the planet.

Moving more manufacturing of surgical supplies closer to hospitals — or choosing to source from suppliers that are locally based — could also reduce the OR’s carbon footprint.

You know, like finding locally-sourced strawberries in February, in Maine.

Reimagining care delivery

But perhaps the broadest way the oncology space could cut down on its greenhouse gas emissions is to change how surgical care is delivered, starting with permanently offering telemedicine.

What is “offered” by authorities always ends upbeing mandated — always.

“We think telemedicine is a great opportunity for us to lower the climate impact and improve the quality of care by doing so,” Agbafe said. “During the pandemic, we’ve been using virtual care and if we could make that a routine aspect of cancer care for pre-op and post-op, that’s a way we can reduce the climate impact of delivering care and make it more convenient for patients.”

Reducing low-value care is another way to eliminate carbon-producing activities associated with unnecessary scans, testing and procedures.

From gas to (more sustainable) gas

Some sustainability shifts may come even sooner at Michigan Medicine.

For instance, the Department of Anesthesiology recently launched the Green Anesthesia Initiative, or GAIA for short. Its mission: become more environmentally conscious about the types and rates of anesthesia its providers use, another area Agbafe and Berlin say is ripe for improvement.

“This is a topic of fairly intense discussion right now in the field, and I’ve been thinking about it for a while,” said George Mashour, M.D., Ph.D., the chair of the Department of Anesthesiology and the Robert B. Sweet Professor of Anesthesiology at the University of Michigan Medical School. “Unlike other industries, I don’t think that we require massive disruption in order to make progress because, fortunately, we have options.”

A mallet to the head worked for centuries, for instance, and you didn’t see global warming back then, did you?

“The contributions in terms of greenhouse gas effect or ozone-depleting action partly relate to how much is getting pumped out into the atmosphere and that relates directly to how high we have our fresh gas flow,” he added. “If we have, for example, 10 liters going, we’re blowing a lot of anesthetic into the scavenging and waste and atmospheric systems that doesn’t need to be there.”

To that end, Mashour’s colleagues in the Department of Anesthesiology are already leading a national initiative to try to reduce anesthetic gas flow rates through the Multicenter Perioperative Outcomes Group, another quality initiative that includes health centers from across the country.

“Oh, does that hurt? Okay, we’ll turn up the volume a little more for the next patient — that’s why we’re experimenting here, to learn.”

Mashour plans to roll out other elements of GAIA over a three- to- five-year period.

“We could be doing better,” he said. “Right now, we’re starting the conversations, getting people on board and making structural choices in the department to help make it easy for people to do the right thing.”

“The right thing” being, of course, to simply die, preferably in pain, to atone for the sins of mankind and the insult to Mother Gaia.

Look for new state of the art private cancer centers to open in Davos and Monte Carlo soon. Look, but don’t go in: you’re not invited