Australian and New Zealand surgeons' attitudes to our role in climate change mitigation

Climate change is a major threat to global health, with over 250 000 fatalities per year attributable to the climate crisis.1 Despite the link between carbon emissions and poor health, the Australian healthcare system contributes to 7% of Australia's carbon footprint,2 with surgery a large contributor.3 Understanding surgeons' attitudes towards these emissions is essential to aid in their reduction. This study presents the most comprehensive description to date of Australian and New Zealand surgeons' practices and attitudes to climate change mitigation. An electronic, cross-sectional survey was developed by experts on healthcare climate change mitigation (Appendix 1). The project was approved by our organization's Human Research Ethics Committee (ref:QA2022040). The survey was distributed to members of the Royal Australasian College of Surgeons (RACS) via the RACS newsletter and electronic magazine. Data was collected for 107 days. Frequencies were recorded using Likert attitude scales. Reflexive, inductive thematic analysis was applied to qualitative data.4 Two hundred and fifty-three eligible responses were collected. Most respondents identified as male (76%) and consultants (>10 years of experience) (70%). Most practiced General Surgery (37%) or Orthopaedic Surgery (19%). 72% of respondents strongly agreed/agreed that climate change is an urgent public health crisis, with 78.7% indicating that they make personal choices outside work to reduce their carbon footprint. Appendices 2 and 3 further detail quantitative results. Respondents indicated the frequency (Almost Always/Often/Occasionally/Never) at which they currently engage in behaviours to minimize their carbon footprint. They were subsequently asked how these behaviours would change if provided with supporting evidence/ guidelines. Overall, there was a trend for surgeons to change their behaviour to Almost Always or Often engage in environmentally sustainable behaviours if evidence and guidelines were provided (Fig. 1). This finding supports a need for increased research, organizational guidelines and policy on the environmental impact of reusable equipment, recycling of theatre waste and the carbon footprint of perioperative investigations. Figure 2 summarizes respondents' views regarding the role of RACS and the surgical device industry in climate change mitigation. The majority of respondents strongly agreed/agreed that RACS should advocate for environmental sustainability in health policy and strategy (78.5%), encourage the surgical device industry to become carbon neutral (75.3%), provide guidance and education to surgeons on the most carbon-efficient approaches to patient care (73.1%), and fund research into low carbon treatment pathways (69%). These sentiments were supported in the qualitative findings, with ‘Advocacy’ and ‘Education and Research’ frequently identified as ‘the most important actions RACS can take on climate change’. Other themes included waste reduction and recycling, industry involvement, auditing of surgical carbon emissions and travel reduction. The majority of respondents agreed that the surgical device industry has a role in climate change mitigation. 69.9% of respondents strongly agreed/agreed that industry should provide data on carbon emissions associated with the production of products. Respondents strongly agreed/agreed that industry should fund research on low carbon emission products, provide reusable versions of products (>70%) and provide recycling options (>85%). The importance of reusable and recyclable options was supported by free-text responses. We acknowledge limitations to this study. Overall, there was a 0.04% response rate. This may have been improved with increased distribution of the survey to RACS members, and with follow-up reminders. Furthermore, we acknowledge that respondents, by nature of making the time to complete the survey, are perhaps more likely to be climate change advocates. Despite the large nonresponse bias the respondents' demographic data was relatively representative of RACS members.5 Australian and New Zealand surgeons are calling on RACS, the surgical industry, and government to act on climate change. Surgeons identify education and guidelines, recycling, reusable products and advocacy as important strategies to reduce carbon emissions in surgery. Johanna J. Mousley: Data curation; investigation; methodology; project administration; writing – original draft; writing – review and editing. Steven Simpson-Yap: Formal analysis; methodology; visualization; writing – review and editing. Maggie Yu: Data curation; formal analysis; writing – review and editing. David Fletcher: Project administration; writing – review and editing. Ben Dunne: Conceptualization; data curation; formal analysis; investigation; methodology; project administration; supervision; visualization; writing – review and editing. Appendix S1. Appendix S2. Appendix S3. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.