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Background <p>The healthcare industry is a significant contributor to greenhouse gas (GHG) emissions, with sustainability efforts largely focused on reducing operating room waste. However, the environmental impact of postoperative care pathways is an emerging area of interest. In colorectal surgery, enhanced recovery protocols (ERPs) were developed to improve postoperative outcomes, leading to the adoption of same-day discharge (SDD) as a further refinement, offering similar results with shorter hospital stays. Despite these advancements, the differences in healthcare-related emissions between these pathways remain unexplored.</p> Methods <p>A prospective cohort of adult patients undergoing minimally invasive colectomy or stoma reversal and managed through a standardized same-day discharge (SDD) protocol was compared to a matched retrospective cohort of patients managed through enhanced recovery protocols (ERPs). The study was conducted at a university-affiliated colorectal center between 2017 and 2022. Carbon emissions associated with each care pathway were quantified using the “New Care Pathways Carbon Footprint Calculator,” developed by the Sustainable Healthcare Coalition in collaboration with the NHS (<a href="https://shcpathways.org/full-calculator/">https://shcpathways.org/full-calculator/</a>). Secondary outcomes included postoperative complications, hospital readmissions, and emergency department (ED) visits.</p> Results <p>Among 689 screened adult patients, 121 underwent SDD, while 413 were managed through ERP. Carbon emissions were significantly lower in the SDD cohort for colectomy patients (322 kgCO<sub>2</sub>e vs. 421 kgCO<sub>2</sub>e, <i>p</i> = 0.01); however, no significant difference was observed for stoma reversal (279 kgCO<sub>2</sub>e vs. 247 kgCO<sub>2</sub>e, <i>p</i> = 0.57). The SDD cohort experienced a shorter hospital stay but had higher 30-day readmission rates (11% vs. 4%, <i>p</i> = 0.03) for patients undergoing colectomy and increased ED visits among stoma reversal patients (28% vs. 7%, <i>p</i> = 0.04).</p> Conclusion <p>SDD pathways reduce the carbon footprint for colectomy patients, highlighting a potential environmental benefit of shorter hospital stays. However, increased ED visits and readmissions warrant further investigation to optimize patient selection and postoperative care. As healthcare systems pursue sustainability, integrating environmentally conscious care pathways remains essential for balancing patient outcomes with planetary health.</p>

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The environmental impacts of surgical care pathways: same-day-discharge versus enhanced recovery following minimally invasive colectomy and stoma reversal

  • 期刊论文

  • 发表日期：

    2026年3月18日

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  • Tiffany Paradis,
  • Camille Gervais,
  • Neyla Boukhili,
  • Stephan Robitaille,
  • Anne Mahalia Olivier,
  • Patrick Charlebois,
  • Barry S. Stein,
  • A. Sender Liberman,
  • Julio F. Fiore,
  • Liane S. Feldman,
  • Lawrence Lee

摘要

Background

The healthcare industry is a significant contributor to greenhouse gas (GHG) emissions, with sustainability efforts largely focused on reducing operating room waste. However, the environmental impact of postoperative care pathways is an emerging area of interest. In colorectal surgery, enhanced recovery protocols (ERPs) were developed to improve postoperative outcomes, leading to the adoption of same-day discharge (SDD) as a further refinement, offering similar results with shorter hospital stays. Despite these advancements, the differences in healthcare-related emissions between these pathways remain unexplored.

Methods

A prospective cohort of adult patients undergoing minimally invasive colectomy or stoma reversal and managed through a standardized same-day discharge (SDD) protocol was compared to a matched retrospective cohort of patients managed through enhanced recovery protocols (ERPs). The study was conducted at a university-affiliated colorectal center between 2017 and 2022. Carbon emissions associated with each care pathway were quantified using the “New Care Pathways Carbon Footprint Calculator,” developed by the Sustainable Healthcare Coalition in collaboration with the NHS (https://shcpathways.org/full-calculator/). Secondary outcomes included postoperative complications, hospital readmissions, and emergency department (ED) visits.

Results

Among 689 screened adult patients, 121 underwent SDD, while 413 were managed through ERP. Carbon emissions were significantly lower in the SDD cohort for colectomy patients (322 kgCO2e vs. 421 kgCO2e, p = 0.01); however, no significant difference was observed for stoma reversal (279 kgCO2e vs. 247 kgCO2e, p = 0.57). The SDD cohort experienced a shorter hospital stay but had higher 30-day readmission rates (11% vs. 4%, p = 0.03) for patients undergoing colectomy and increased ED visits among stoma reversal patients (28% vs. 7%, p = 0.04).

Conclusion

SDD pathways reduce the carbon footprint for colectomy patients, highlighting a potential environmental benefit of shorter hospital stays. However, increased ED visits and readmissions warrant further investigation to optimize patient selection and postoperative care. As healthcare systems pursue sustainability, integrating environmentally conscious care pathways remains essential for balancing patient outcomes with planetary health.