Environmental Impact of Lumbar Disc Herniation Surgery: A Comparative LCA Study of Open and Endoscopic Procedures

Abstract

Denne kandidatafhandling præsenterer en komparativ livscyklusvurdering (LCA) af to kirurgiske procedurer til behandling af lumbal diskusprolaps: åben og endoskopisk procedure. Undersøgelsen er udført i samarbejde med Aarhus Universitetshospital (AUH), Aalborg Universitetshospital (AaUH) og Center for Bæredygtige Hospitaler i Region Midtjylland. Formålet er at kvantificere og sammenligne de miljømæssige påvirkninger af hver procedure gennem hele patientforløbet. Ved brug af en konsekvensbaseret LCA-tilgang samt EXIOBASE og hybrid processer identificerer studiet bidragende faktorer såsom engangsudstyr, energiforbrug og udgifter til indlæggelse. Resultaterne viser, at den endoskopiske procedure generelt har en lavere miljøpåvirkning sammenlignet med den åbne procedure, primært på grund af kortere indlæggelses- og operationstid, hvilket medfører reduceret forbrug, såsom elforbrug. Dog er faktorer som patientegnethed og indlæringskurver for det kirurgiske personale ved overgang til den endoskopiske metode vigtige at tage i betragtning før en fuld implementering. Afhandlingen reflekterer over de epistemologiske og ontologiske antagelser i LCA-modellering samt de kommunikationsmæssige udfordringer mellem systemverdenens modellering og livsverdenen i klinisk praksis. Resultaterne bidrager til det overordnede mål om at integrere bæredygtighed i beslutningstagning i sundhedsvæsenet og understreger behovet for datadrevne, men kontekstsensitive tilgange.

This master’s thesis presents a comparative Life Cycle Assessment of two surgical procedures for treating lumbar disc herniation; open and endoscopic procedure. The study is conducted in collaboration with Aarhus University Hospital (AUH), Aalborg University Hospital (AaUH), and the Center of Sustainable Hospitals in the Central Denmark Region. It aims to quantify and compare the environmental impact of each procedure across their individual patient pathway. Using a consequential LCA approach along with EXIOBASE and hybrid processes, the study identifies contributing factors such as single use equipment, energy consumption, and admission expenditures. The results conclude that the endoscopic procedure generally have a lower environmental impact compared to the open procedure, primarily due to reduced admission and surgery duration, resulting in reduction in consumption such as electricity use. However, factors such as patient suitability and learning curves for surgical staff in the conversion of the endoscopic procedure are important to consider before a full implementation. The thesis reflects on the epistemological and ontological assumptions in LCA modelling, as well as the communication challenges between system-world modelling and life-world in clinical practice. The findings contribute to the broader goal of integrating sustainability into healthcare decision-making and underscore the need for data driven but context sensitive approaches.

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A master programme thesis from Aalborg University

Environmental Impact of Lumbar Disc Herniation Surgery: A Comparative LCA Study of Open and Endoscopic Procedures