Perceptions and Priorities of Perioperative Staff and the Public for Sustainable Surgery: a Validated Questionnaire Study.

Background:Surgery is a substantial contributor to healthcare-related emissions. Despite a drive to improve sustainability, few interventions have been adopted. Stakeholder engagement is considered a key barrier to implementation. This study aimed to determine the attitudes and beliefs of the perioperative staff and the public regarding sustainability initiatives in surgery, and whether differences exist between the two groups. Materials and Methods:Separate validated healthcare professional and public questionnaires were developed using a stepwise process. A systematic review was undertaken using Medline, Embase and Cochrane to identify key domains pertaining to sustainability and ensure content validity. Initial questionnaires were developed and refined using an iterative process of feedback from focus groups. Psychometric validation was conducted to remove question ambiguity. The final validated questionnaire was distributed to perioperative staff and the public using a multimodal approach involving online tools and in person. Results:Only 37.1% of perioperative staff reported the implementation of sustainability initiatives in their departments. Yet, staff (45.7%) and the public (48.2%) somewhat agreed that sustainability should influence a surgeon's procedural decision-making. Insufficient staff education regarding sustainability was a potential cause for the lack of adoption, with 71.4% reporting they had no formal training. Moreover, discrepancies in the perceived importance of sustainability may have contributed. Staff and the public agreed that outcomes (38.6 vs. 42.7%, P=0.767) and surgeon experience with a technique (28.6 vs. 40.0%, P=0.082) were more important than sustainability. However, 40.9% of the public did not consider operative time an important factor compared to sustainability, while 45.7% of staff would only tolerate procedures 25% longer. Conclusions:Engaging stakeholders is central to implementing long-term environmentally sustainable initiatives in surgery without compromising patient outcomes. More work is needed to understand the relative trade-offs considered by perioperative staff and the public, as well as provide both groups with more pertinent education on ecological outcomes.