Evaluating the Environmental Impact of Quaternary Plastic Surgery: An Eco-audit of the Autologous Microtia Reconstruction Pathway.

Background: Autologous microtia reconstruction is a highly specialized procedure with the potential to significantly improve patient quality of life. However, it has a complex patient pathway including a multistaged procedure, the environmental impact of which has yet to be explored. Methods: A retrospective study of 23 patients undergoing autologous microtia reconstruction at a single center was performed. Process mapping and life cycle analyses were performed for surgical and inpatient stay, including facilities, consumables, medical gases, equipment, food and linen, and travel. Estimates for carbon dioxide emissions were generated for each stage of the care pathway, with variability considered, as well as potential areas of savings. Results: This study estimated the carbon footprint of a patient undergoing autologous microtia reconstruction surgery to be approximately 1004.5 kgCO2eq. Inpatient stay had the highest overall contribution to the carbon footprint (447.5 kgCO2eq, 44.6% overall). From bottom-up calculations, patient travel was the predominant source of carbon emissions (464.2 kgCO2eq, 83.4%). Conclusions: This was the first study to estimate the carbon footprint of a quaternary plastic surgery procedure, using autologous microtia reconstruction as an example. Strategies to combat the impact of carbon emissions, including adapted models of care in a hub-and-spoke model, reduction in the use of anesthetic gases, and facilitating sustainable staff travel, were suggested areas for improvement.