Potential impacts of optimised care pathways on carbon impact of anaesthesia consultation - a monocenter prospective study

Background: Global warming presents major public health challenges, with healthcare transportation significantly contributing to carbon dioxide equivalent emissions (eCO₂). While the greenhouse effects of anaesthetic gases are well-documented, the eCO₂ of pre-anaesthesia consultations remains underexplored. This study aims to evaluate and propose strategies to reduce the carbon impact of these consultations at a Tertiary University Hospital.

Methods: In a prospective, observational study over one month, data were collected from patients attending pre-anaesthesia consultations. ECO2 emissions from transportation and electricity were calculated. To reduce emissions, several modifications to the care pathway were investigated, including teleconsultation, remote consultation, grouping of consultations, carpooling, and the promotion of public transport. The effects of current and optimised care pathways were then compared.

Results: Data from 213 patients showed that 75% attended the hospital solely for pre-anaesthesia consultations, mostly by car (82%). The mean eCO₂ per consultation was 22.4 kgCO2 (95% CI: 14.6-30.2). Implementing optimisation strategies in 65% of cases could reduce emissions to 5.6 kgCO2 (95% CI: 0.2-10.9) per consultation, leading to a 74% reduction and an annual saving of 274 tonnes of eCO₂.

Discussion: Our study highlights the potential for significant reductions in the eCO₂ of pre-anaesthesia consultations. The adaptation of the care pathway would largely involve grouping consultations and developing teleconsultations. These potential savings in greenhouse gas emissions are in the same order of magnitude as not using desflurane in the operating theatre and could be the next step towards greener anaesthesia.