eprintid: 10204533 rev_number: 7 eprint_status: archive userid: 699 dir: disk0/10/20/45/33 datestamp: 2025-02-11 10:24:02 lastmod: 2025-02-11 10:24:02 status_changed: 2025-02-11 10:24:02 type: article metadata_visibility: show sword_depositor: 699 creators_name: Iakovou, Despoina creators_name: Sousi, Sara creators_name: Glynou, Sevasti Panagiota creators_name: Ahmed, Zahra creators_name: Zargaran, Alexander creators_name: Zargaran, David creators_name: Mosahebi, Afshin title: A systematic review of sustainability practices in plastic surgery ispublished: pub divisions: UCL divisions: B02 divisions: C10 divisions: D16 divisions: G85 keywords: Sustainability; Plastic surgery; Carbon footprint; Ecology; Healthcare note: Copyright © 2025 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). abstract: Aim: There is an urgent need to mitigate the environmental impact of surgery, with surgery representing a major contributor to carbon emissions. This study explores literature detailing current sustainability practices and initiatives in plastic surgery and evaluates methods used to facilitate the attainment of net zero targets. // Methodology: Following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, a systematic search was performed using MEDLINE, EMBASE and Cochrane Library databases (PROSPERO registration number CRD42023446104). Studies pertaining to sustainability practices in plastic surgery were included. // Results: An initial search yielded 1083 studies, of which 15 met inclusion criteria. The studies were analysed for data on waste, carbon footprint and cost reduction. Hand surgery was the leading subspecialty with initiatives to tackle waste, such as using procedure-specific surgical packs of the Wide-Awake Local Anaesthesia No Tourniquet technique, while also considering surgeons’ preferences. Other initiatives were implemented in craniofacial, skin cancer and breast surgery. Successful recycling initiatives were reported with a monthly average of 39.6 tonnes of waste redirected to be recycled per month. Five studies, from skin and hand surgery, demonstrated a simultaneous benefit through reduction in cost by individualising sustainability practices for specific procedures. The average carbon footprint per procedure, of the included studies reporting emissions, was 22.7 kgCO2-eq. // Conclusion: This systematic review demonstrated the necessity of an agile approach towards implementing sustainability practices, tailoring sustainability strategies to the requirements of each surgical procedure. The development of standardised outcome sets to evaluate the best practices in sustainability was emphasised. date: 2025-03 date_type: published publisher: Elsevier BV official_url: https://doi.org/10.1016/j.bjps.2025.01.027 oa_status: green full_text_type: pub language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 2359719 doi: 10.1016/j.bjps.2025.01.027 lyricists_name: Sousi, Sara lyricists_id: SSOUS87 actors_name: Sousi, Sara actors_id: SSOUS87 actors_role: owner full_text_status: public publication: Journal of Plastic, Reconstructive & Aesthetic Surgery volume: 102 pagerange: 104-113 issn: 1748-6815 citation: Iakovou, Despoina; Sousi, Sara; Glynou, Sevasti Panagiota; Ahmed, Zahra; Zargaran, Alexander; Zargaran, David; Mosahebi, Afshin; (2025) A systematic review of sustainability practices in plastic surgery. Journal of Plastic, Reconstructive & Aesthetic Surgery , 102 pp. 104-113. 10.1016/j.bjps.2025.01.027 <https://doi.org/10.1016/j.bjps.2025.01.027>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10204533/1/PIIS1748681525000300.pdf