Sustainability of Laparoscopic Appendectomy. Variability of Determining Factors.

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Today, evidence shows that environmental changes significantly affect human health. The healthcare sector itself is a major emitter of environmental pollutants. It is responsible for 4-5% of global greenhouse gas emissions. The Declaration of Helsinki urges us to protect both human and planetary health, emphasizing the urgency of adopting strategies with a sustainable approach. Objective: To estimate the sustainability of laparoscopic surgery for acute appendicitis at Dr. Hernán Henríquez Aravena Hospital. Methodology: This is a quantitative observational study with a longitudinal analytical design. It will be conducted at Dr. Hernán Henríquez Aravena Hospital in Temuco, Chile. Data will be obtained prospectively through direct collection in the operating room and, when necessary, from the hospital database. Sustainability is defined in three dimensions. One dimension is economic; therefore, a cost analysis with an operational focus will be conducted. A social dimension will be considered, expressed in the clinical effectiveness of laparoscopic appendectomy in terms of DALYs (Disability-Adjusted Life Years). Finally, the environmental impact of laparoscopic appendectomies will be analyzed. To this end, an environmental impact study will be conducted in accordance with ISO 14040, using the CCALC database and OpenLCA software to estimate CO₂e emissions of greenhouse gases (GHG). The processes and products required to perform each appendectomy will be considered, from the moment the patient enters the operating room until their discharge. Analysis: Emissions from each surgery will be estimated. Factors such as surgical time, the number of operators involved, and the surgical and anesthetic resources used will be explored. The main result will be the calculation of the Environmental Impact-Effectiveness, considered as the average value. This will generate an indicator expressed in CO₂eq/Euros/average DALYs avoided. This indicator will allow it to describe variability in resource use during interventions, as well as the surgical intervention's carbon footprint and the costs per DALY (Disability-Adjusted Life Year) avoided. Results: Determination of the sustainability of each surgical procedure and identification of gaps or practices that can improve its sustainability. Development of a matrix of recommendations to improve the clinical sustainability of appendectomies.

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