Environmental Impact of a Vaginal Pelvic Organ Prolapse Procedure: A Life Cycle Assessment with Scenario Modelling of Mitigation Strategies.

INTRODUCTION AND HYPOTHESIS: Surgical treatment of pelvic organ prolapse (POP) contributes to healthcare-related emissions, yet its specific environmental impact remains unknown. We hypothesized that a life cycle assessment (LCA) would identify carbon hotspots and reveal potential mitigation strategies. METHODS: We conducted a multicentre cradle-to-grave LCA of 18 vaginal POP procedures (Manchester procedure n = 6, sacrospinous hysteropexy n = 6, vaginal hysterectomy with colporrhaphy n = 6) performed in three Dutch hospitals (academic n = 1, teaching n = 2). The LCA was performed according to ISO14040/44 guidelines and ReCiPe 2016 methodology. The primary outcome was the global warming potential (GWP) of one vaginal POP procedure. Secondary outcomes included the identification of carbon hotspots and modelling of potential mitigation strategies. RESULTS: The mean GWP of a POP procedure was 72.5 (95% CI 61.5, 83.5) kg CO2-equivalent (kg CO2-eq). The carbon hotspots were disposables (34%, 24.2 (95% CI 22.6, 26.0) kg CO2-eq), staff commuting (22%, 15.7 (95% CI 10.7, 20.8) kg CO2-eq, and patient travel (16%, 11.6 (95% CI 6.4, 16.9) kg CO2-eq). Mitigation modelling suggested that sustainable commuting (e.g. fully substituting car travel with public transport) could reduce emissions by 18.3%, transitioning to renewable energy sources by 8.6%, and a 20% reduction of surgical drape weight reduced emissions by 3.9%. CONCLUSIONS: A POP procedure is associated with a considerable GWP, with disposables, staff commuting and patient travel identified as the key contributors. Several mitigation strategies offer meaningful opportunities to reduce emissions. These insights support the development of evidence-based strategies by clinicians and policymakers to enhance the environmental sustainability of POP surgery.