The Operating Theatre Journal April 2022

New research shows Surgical Site Infection prevention, and
achieving First-Pass Recanalization in Mechanical Thrombectomy
could lead to environmental benefits for the NHS
The NHS faces a new challenge – it needs to continue providing worldclass
healthcare whilst striving to meet its net zero carbon goal 1 . New
research has demonstrated that it is possible to reduce environmental
impact by improving patient outcomes in two areas: reducing surgical
site infections across the NHS 2 and achieving first pass recanalization in
mechanical thrombectomy 3 .
The research was presented at The International Society of
Pharmaeconomic and Outcomes Research (ISPOR) European conference
in December by Mesut Kocaman, EMEA Health & Economics Market
Access Manager for Johnson & Johnson Medical Devices. Environmental
impact models were used to analyse the influence treatment options
can have on sustainability, keeping in mind the NHS’s objective to reach
net zero carbon emissions by 2040 1 .
The first study explored the impact of surgical site infections (SSIs)
across NHS England – demonstrating SSIs were associated with 10
additional days in hospital, 4.1 additional outpatient appointments, and
22% more A&E visits compared with patients without SSIs 2 . Due to the
additional resources required, the analysis demonstrated reducing one
SSI could save 0.58 tonnes of CO2e (equivalent to two return flights from
London to Rome), 5m³ of direct water use and 0.06 tonnes of waste 2 .
The annual cost to NHS England of SSI-associated environmental impact
was estimated to be £2.67million 2 .
Jennifer Nagy, UK General Manager for Ethicon, part of Johnson &
Johnson Medical Devices Companies, says:
“Supporting our NHS to continue improving patient outcomes is our
organization’s number one priority, but we also have a responsibility
to promote a sustainable healthcare system. Our Plus Sutures were
recognized by NICE in June 2021, the report highlighted their potential
environmental benefits by preventing surgical site infections 4 , and it’s
great that this study shows what the potential environmental impact
of reducing SSIs could be.”
The second study focused on mechanical thrombectomy – a procedure
which uses a mechanical thrombectomy device to remove a clot
from the brain during acute ischemic stroke. Previous studies have
demonstrated that achieving complete or near complete reperfusion
(modified Thrombolysis in Cerebral Infarction (mTICI) grade 2c-3) after a
single pass can result in improved clinical outcomes 5 ; the new research
was to explore if there was also an environmental benefit. The study
showed that the decrease in resource utilisation by achieving mTICI
2c-3 after a single pass (first pass recanalization) led to a 134 kg drop
in CO2e and a reduction of 13 kg of waste compared to the patients
who achieved the same result after multiple passes 3 . In the UK, it is
estimated that there are approximately 10,000 patients eligible for
mechanical thrombectomy due to acute ischemic stroke 6 . Achieving a
40% rate of first pass recanalization could save as much as 51 tonnes
of waste each year and 536 tonnes of CO2e - equivalent to 2,500 round
trip flights from London to Milan 3 .
Andrew Cleworth, who leads Cerenovus stroke solutions, part of the
Johnson & Johnson Family of Companies, which makes products and
technologies used during mechanical thrombectomy procedures, says:
“The NHS long term plan includes expanding access to mechanical
thrombectomy from 1% to 10% of stroke patients 7 . At Cerenovus we
want to change the trajectory of stroke together with the NHS and
reach as many patients as possible. This research demonstrates that
by removing clots from the brain successfully at the first pass, not only
can we improve patient outcomes, we can also help the NHS meet its
net zero goal.”
The full results can be found here for surgical site infections and here
for mechanical thrombectomy - https://bit.ly/OTJ422
References:
1. NHS (2020). Delivering a ‘Net-Zero’ National Health Service. Available at:
https://www.england.nhs.uk/greenernhs/a-net-zero-nhs/. Accessed: January
2022.
2. Kocaman M, Galvain T. The Cost Analysis of the Environmental Impacts of
Surgical Site Infection from the Perspective of NHS England. Value in Health,
Volume 24, Issue 12, S2 (December 2021)
3. Kocaman M, Taylor H. The Environmental Impact of the First Pass Effect in
Mechanical Thrombectomy in the NHS. Value in Health, Volume 24, Issue 12,
S2 (December 2021)
4. © NICE 2021. MEDICAL TECHNOLOGY GUIDANCE: PLUS SUTURES FOR
PREVENTING SURGICAL SITE INFECTION. Available from: nice.org.uk/
guidance/MTG59. Accessed: January 2022. All rights reserved. Subject to
Notice of rights. NICE guidance is prepared for the National Health Service in
England. All NICE guidance is subject to regular review and may be updated
or withdrawn. NICE accepts no responsibility for the use of its content in this
product/publication.
5. ZaidatOO, RiboM, MattleHP, SaverJL, Bozorgchami H et al. (2020) Health
economic impact of first-pass success among patients with acute ischemic
stroke treated with mechanical thrombectomy: a United States and European
perspective. Journal of Neurointerventional Surgery.
6. McMeekin P, White P, James MA, Price CI, Flynn D et al. (2017) Estimating
the number of UK stroke patients eligible for mechanical thrombectomy.
European Stroke Journal 2(4): 319-326.
7. NHS. The NHS Long Term plan. Available from: https://www.longtermplan.
nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf
Accessed: January 2022.
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