Evidence map›Paper›PMID 40396251›Full record

SynthesisAnnals of surgery2026

Evidence-based Integration of Environmental Sustainability into Clinical Guidelines for Operating Rooms: A Systematic Review.

Kim E van Nieuwenhuizen, Charlotte T J Michels, Ingena G I A Both, Jeroen B Guinée, Frank Willem Jansen, Dutch Expert Panel

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Annals of surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Increasing the environmental sustainability of operating rooms in Canada: an evidence-informed guideline for policy.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2026
    Guideline
  3. Article
  4. Review
  5. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2026
    Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Kim E van NieuwenhuizenDepartment of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands.ORCID 0000-0001-8531-4778
Charlotte T J MichelsKnowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands.
Ingena G I A BothDepartment of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands.
Jeroen B GuinéeDepartment of Industrial Ecology, Institute of Environmental Sciences (CML), Leiden University, Leiden, The Netherlands.
Frank Willem JansenDepartment of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands.
Dutch Expert Panel

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo assess the feasibility of integrating environmental sustainability into clinical guidelines for operating rooms (ORs) and provide evidence-based recommendations.

backgroundSurgical practices contribute significantly to health care's environmental impact. Incorporating sustainability into evidence-based clinical guidelines can support environmentally responsible decision-making. However, guidance on integrating environmental considerations into clinical recommendations remains limited.

methodsA systematic review was conducted on the environmental impact of ORs, focusing on 5 key topics: (1) surgical techniques, (2) disposables versus reusables, (3) cover materials, (4) anaesthesia, and (5) OR ventilation. The search was conducted in December 2022 in PubMed (through NCBI), Embase (through OVID), Web of Science (through Webofscience), Cochrane (through Cochrane Library), and Emcare (through OVID). The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence and formulate recommendations.

resultsA total of 42 studies were included, of which 28 employed life cycle assessment (LCA) methods. Grading of Recommendations, Assessment, Development, and Evaluation assessments indicated "very low" to "low" quality of evidence. Key contributors to the OR environmental impact included energy-intensive and resource-intensive surgical technologies, reliance on disposables, anaesthetic gas emissions, and energy consumption for OR ventilation.

conclusionsDespite "very low" to "low" levels of evidence, environmental outcomes consistently point in the same direction. Studies using LCA methods are instrumental in identifying environmental hotspots for targeted mitigation. Integrating LCA findings into clinical guidelines can support sustainability efforts in surgery, helping guideline panels develop evidence-based recommendations that promote environmentally responsible practices.

Indexed as

Operating RoomsPractice Guidelines as TopicEvidence-Based MedicineHumansclinical guidelinesenvironmental impactenvironmental sustainabilityGRADElife cycle assessmentoperating roomsurgery

Identifiers

PMID40396251
PMCPMC12978700

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.