SusQI case study: The upper “hand” of sustainability: Reducing the carbon footprint in hand surgery

Rachel McLean's picture


Resource Description: 

SusQI project completed in North Wales at Wrexham Maelor and Ysbyty Gwynedd Hospitals, Betsi Cadwaladr University Health Board (BCUHB) as part of the Green Surgery Challenge, 26/04/2021 – 07/07/2021. The case study attached has been updated to reflect progress as of April 2022. 


Aims: To reduce the carbon footprint of carpel tunnel release (CTR) surgery by;

  1. adapting a “lean and green theatre set up” by reducing the number of single use instruments, trays and drapes used per procedure; and
  2. transforming to a “Green CTR patient pathway” by utilizing a minor procedure room (instead of theatre) and therefore bypassing the pre-theatre ward admission process.

Methods: A multidisciplinary team identified ‘hotspots’ leading to identified aims. A green patient pathway was proposed for elective day case hand surgery under local anaesthetic in minor procedure room”. Streamlined ‘minor hand procedure’ sets were agreed on and large generic limb drapes were replaced with two small 90cm square drapes. Use of a minor procedures room instead of a theatre was approved. 4 pilot Lean and Green Hand Surgery lists involving 17 patients utilising interventions above took place June - July 2021.

Measurement: A detailed itinerary of consumables used in theatre was obtained from procurement. We calculated the carbon footprint of patients’ journey through the hospital from admission onto a ward, transfer to the theatre suite and finally return to the ward prior to being discharged home. We calculated the cost savings and efficiency of this model per each CTR.

Results: Positive outcomes for both patients and staff were found; including reduced length ofstay, reduced theatre list and surgical wait times, and reduced the number of staff required per procedure. Changing to a “Lean and Green” set up demonstrated a 31kg CO2 and £33.71 reduction per case. This is an 80% reduction of the carbon footprint and 65% of the total cost.

Conclusions: This project demonstrated that a lean theatre set up and green patient pathway can deliver a safe, efficient, cost-effective and sustainable hand surgery service within an orthopaedic department. The preliminary results from our green pathway will hopefully soon be seen as the “Standard of Practice” in the two hospitals involved in this project. By upscaling to the whole of the UK, in which 53,000 CTRs are undertaken each year, we estimate the carbon footprint could be reduced by 1,643,000 Kg of CO2e.


  • Preetham Kodumuri, Consultant Hand & Orthopaedic Surgeon
  • Prash Jesudason, Consultant Hand & Orthopaedic Surgeon
  • Jack Houghton, Specialty doctor in Orthopaedics
  • Shan Roberts, Theatre Practitioner
  • Iona Williamson, Sterile Services Manager
  • Teresa Revell, Deputy Team Leader Day Case Unit

You can read more about the project by downloading the attached case study or at this link: Introducing team 4 of the Green Surgery Challenge | Centre for Sustainable Healthcare

You can read more about the Green Surgery Challenge and watch the recording here: Green Surgery Challenge | Centre for Sustainable Healthcare

Resource File: 

Publication date: 

August, 2022

Resource type: 

  • case study

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