A cost comparison analysis of environmentally sustainable interventions in colorectal surgery.

BACKGROUND

Operating theaters are significant contributors to hospital carbon emissions, with colorectal surgery offering substantial opportunities for sustainable transformations. Financial assessments are critical to aid sustainable implementation within health care organizations. We conducted a cost comparison analysis of substituting disposable surgical items with their reusable counterparts in colorectal surgeries.

METHODS

This was a prospective cost comparison study across 65 consecutive elective laparoscopic colorectal resections at a single UK center. Interventions included reusable laparoscopic ports/trocars, a reusable harmonic device, and reusable textiles (gowns, drapes, and slide sheets). Costs were analyzed using a per-case unit (capital amortized over expected lifetime + per-use sterilization/laundering). We also conducted a two-way sensitivity analysis and a threshold (break-even) analysis with 6% discounting over a 5-year life span.

RESULTS

The total observed savings across 65 cases were £14,239.03. The reusable harmonic device remained cost-saving in all two-way combinations, with savings of £24.7k-£28.5k over 65 cases (baseline of £26.6k). Reusable textiles were consistently cheaper than disposables across modeled volumes. Reusable ports did not demonstrate cost savings at observed volumes and prices and did not reach parity on threshold analysis. Findings were driven by processing costs, capital price, and utilization.

CONCLUSION

Selectively adopted reusables can deliver measurable financial savings, particularly the harmonic device and theatre textiles, whereas other items may remain cost-increasing at current volumes and prices. The per-case, two-way sensitivity framework is transferable and can be populated with local inputs to inform implementation decisions aligned with sustainability aims.