{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T14:51:04Z","timestamp":1787496664613,"version":"build-2736575974"},"reference-count":45,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T00:00:00Z","timestamp":1739750400000},"content-version":"vor","delay-in-days":16,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"ZonMw scholarship","award":["80-86800-98-112"],"award-info":[{"award-number":["80-86800-98-112"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,2,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>OBJECTIVES<\/jats:title>\n                    <jats:p>An urgent transition to environmentally sustainable healthcare is required. The purpose of this study was to identify key areas for environmental impact mitigation for a coronary artery bypass grafting trajectory.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>An ISO14040\/44 standardized life cycle assessment was conducted for the functional unit of an individual patient trajectory of elective coronary artery bypass grafting surgery, from operating room admission until intensive care unit discharge. Data were collected for products, processes, and services required for care delivery in a Dutch academic hospital for 12 patients. The environmental impact was calculated using the ReCiPe 2016 method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A single patient trajectory caused 414 [IQR 383\u2013461] kgCO2 equivalents of global warming, equal to 2753 km of driving an average Dutch petrol-fuelled car. Other notable environmental impacts were fine particulate matter, (non-)carcinogenic toxicity, land use, and terrestrial acidification. Operating room disposable products (162 kgCO2eq), energy use (48 kgCO2eq), and employee commute (36 kgCO2eq) contributed most to global warming. The extracorporeal circulation set, surgical drapes, intraoperative salvage set, surgical gowns, and cotton gauzes caused most of the disposables\u2019 environmental impact. Most energy use occurred in the operating room via heating, ventilation, and air conditioning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>A coronary artery bypass grafting trajectory\u2019s environmental impact primarily contributed to global warming. Most impact mitigation could be achieved by avoiding\/reducing disposable product use when possible or replacing these with reusables. Optimizing operating room energy systems, switching to renewable energy, and encouraging low-emission employee commute can further reduce the environmental impact.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejcts\/ezaf054","type":"journal-article","created":{"date-parts":[[2025,2,13]],"date-time":"2025-02-13T15:24:41Z","timestamp":1739460281000},"source":"Crossref","is-referenced-by-count":14,"title":["Assessing the environmental impact of coronary artery bypass grafting to decrease its footprint"],"prefix":"10.1093","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2770-4097","authenticated-orcid":false,"given":"Egid M","family":"van Bree","sequence":"first","affiliation":[{"name":"Department of Intensive Care Medicine, Radboudumc , Nijmegen,","place":["Netherlands"]},{"name":"Department of Surgery, Maastricht University , Maastricht,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Stobernack","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Radboudumc , Nijmegen,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tadzjo","family":"Boom","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Radboudumc , Nijmegen,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaske","family":"Geene","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Radboudumc , Nijmegen,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma J","family":"Kooistra","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Radboudumc , Nijmegen,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilson","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Radboudumc , Nijmegen,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evelyn A","family":"Brakema","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care, Leiden University Medical Center , Leiden,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Golsteijn","sequence":"additional","affiliation":[{"name":"PR\u00e9 Sustainability , Amersfoort,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pleun","family":"Hemelaar","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Radboudumc , Nijmegen,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"McAlister","sequence":"additional","affiliation":[{"name":"Department of Critical Care, University of Melbourne , Melbourne,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Forbes","family":"McGain","sequence":"additional","affiliation":[{"name":"Department of Critical Care, University of Melbourne , Melbourne,","place":["Australia"]},{"name":"Department of Anaesthesia and Intensive Care, Western Health , Melbourne,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosalie","family":"van Zelm","sequence":"additional","affiliation":[{"name":"Department of Environmental Sciences, Radboud University , Nijmegen,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugo R W","family":"Touw","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Radboudumc , Nijmegen,","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,2,17]]},"reference":[{"key":"2025030423590592500_ezaf054-B1","doi-asserted-by":"crossref","first-page":"2346","DOI":"10.1016\/S0140-6736(23)01859-7","article-title":"The 2023 report of the Lancet Countdown on health and climate change: the imperative for a health-centred response in a world facing irreversible harms","volume":"402","author":"Romanello","year":"2023","journal-title":"Lancet"},{"key":"2025030423590592500_ezaf054-B2","doi-asserted-by":"crossref","first-page":"e271","DOI":"10.1016\/S2542-5196(20)30121-2","article-title":"The environmental footprint of health care: a global assessment","volume":"4","author":"Lenzen","year":"2020","journal-title":"Lancet Planet Health"},{"key":"2025030423590592500_ezaf054-B3","doi-asserted-by":"crossref","first-page":"e949","DOI":"10.1016\/S2542-5196(22)00244-3","article-title":"The environmental impact of the Dutch health-care sector beyond climate change: an input-output analysis","volume":"6","author":"Steenmeijer","year":"2022","journal-title":"Lancet Planet Health"},{"key":"2025030423590592500_ezaf054-B4","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1001\/jama.2019.10823","article-title":"Reducing pollution from the health care industry","volume":"322","author":"Sherman","year":"2019","journal-title":"JAMA"},{"key":"2025030423590592500_ezaf054-B5","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1093\/ejcts\/ezab320","article-title":"Eco-audit of conventional heart surgery procedures","volume":"60","author":"Grinberg","year":"2021","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025030423590592500_ezaf054-B6","doi-asserted-by":"crossref","first-page":"110850","DOI":"10.1016\/j.jclinane.2022.110850","article-title":"Carbon emissions during elective coronary artery bypass surgery, a single center experience","volume":"80","author":"Hubert","year":"2022","journal-title":"J Clin Anesth"},{"key":"2025030423590592500_ezaf054-B7","doi-asserted-by":"crossref","DOI":"10.1136\/openhrt-2023-002279","article-title":"Environmental impact of cardiovascular healthcare","volume":"10","author":"Barratt","year":"2023","journal-title":"Open Heart"},{"key":"2025030423590592500_ezaf054-B8","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1016\/j.atssr.2022.12.013","article-title":"The greenhouse gas emissions associated with cardiothoracic surgery","volume":"1","author":"Blitzer","year":"2023","journal-title":"Ann Thorac Surg Short Rep"},{"key":"2025030423590592500_ezaf054-B9","doi-asserted-by":"crossref","first-page":"104882","DOI":"10.1016\/j.resconrec.2020.104882","article-title":"The Green Print: advancement of Environmental Sustainability in Healthcare","volume":"161","author":"Sherman","year":"2020","journal-title":"Resour Conserv Recycl"},{"key":"2025030423590592500_ezaf054-B10","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1065\/lca2006.02.002","article-title":"The new international standards for life cycle assessment:: ISO 14040 and ISO 14044","volume":"11","author":"Finkbeiner","year":"2006","journal-title":"Int J Life Cycle Assessment"},{"key":"2025030423590592500_ezaf054-B11","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1097\/ALN.0000000000003967","article-title":"Carbon footprint of general, regional, and combined anesthesia for total knee replacements","volume":"135","author":"McGain","year":"2021","journal-title":"Anesthesiology"},{"key":"2025030423590592500_ezaf054-B12","doi-asserted-by":"crossref","first-page":"1779","DOI":"10.1021\/es504719g","article-title":"Environmental impacts of surgical procedures: life cycle assessment of hysterectomy in the United States","volume":"49","author":"Thiel","year":"2015","journal-title":"Environ Sci Technol"},{"key":"2025030423590592500_ezaf054-B13","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1111\/jiec.13012","article-title":"Methodological review and detailed guidance for the life cycle interpretation phase","volume":"24","author":"Laurent","year":"2020","journal-title":"J Ind Ecol"},{"key":"2025030423590592500_ezaf054-B14","author":"Nederlandse Hart Registratie","year":"2023"},{"key":"2025030423590592500_ezaf054-B15","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/j.athoracsur.2023.11.016","article-title":"The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2023 update on procedure data and research","volume":"117","author":"Wyler von Ballmoos","year":"2024","journal-title":"Ann Thorac Surg"},{"key":"2025030423590592500_ezaf054-B16","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1007\/s11367-016-1087-8","article-title":"The ecoinvent database version 3 (part I): overview and methodology","volume":"21","author":"Wernet","year":"2016","journal-title":"Int J Life Cycle Assess"},{"key":"2025030423590592500_ezaf054-B17","volume-title":"Ketenemissies Elektriciteit: actualisatie Elektriciteitsmix 2021","author":"Bruinsma","year":"2023"},{"key":"2025030423590592500_ezaf054-B18","volume-title":"STREAM Personenvervoer 2023","author":"van den Berg","year":"2024"},{"key":"2025030423590592500_ezaf054-B19","volume-title":"ReCiPe 2016: A Harmonized Life Cycle Impact Assessment Method at Midpoint and Endpoint Level Report I: Characterization","author":"Huijbregts","year":"2016"},{"key":"2025030423590592500_ezaf054-B20","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1111\/anae.15482","article-title":"Oral, in place of intravenous, paracetamol as the new normal for elective cases","volume":"76","author":"Myo","year":"2021","journal-title":"Anaesthesia"},{"key":"2025030423590592500_ezaf054-B21","doi-asserted-by":"crossref","first-page":"6580","DOI":"10.1021\/acssuschemeng.8b05473","article-title":"Cradle-to-gate greenhouse gas emissions for twenty anesthetic active pharmaceutical ingredients based on process scale-up and process design calculations","volume":"7","author":"Parvatker","year":"2019","journal-title":"ACS Sustainable Chem Eng"},{"key":"2025030423590592500_ezaf054-B22","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1007\/s11367-013-0670-5","article-title":"Empirically based uncertainty factors for the pedigree matrix in ecoinvent","volume":"21","author":"Ciroth","year":"2016","journal-title":"Int J Life Cycle Assess"},{"key":"2025030423590592500_ezaf054-B23","doi-asserted-by":"crossref","first-page":"e350","DOI":"10.1016\/S2542-5196(24)00092-5","article-title":"How many carbon emissions are saved by doing one less MRI?","volume":"8","author":"McAlister","year":"2024","journal-title":"Lancet Planet Health"},{"key":"2025030423590592500_ezaf054-B24","doi-asserted-by":"crossref","first-page":"e1000","DOI":"10.1016\/S2542-5196(22)00257-1","article-title":"HealthcareLCA: an open-access living database of health-care environmental impact assessments","volume":"6","author":"Drew","year":"2022","journal-title":"Lancet Planet Health"},{"key":"2025030423590592500_ezaf054-B25","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1056\/NEJMoa1816476","article-title":"Volatile anesthetics versus total intravenous anesthesia for cardiac surgery","volume":"380","author":"Landoni","year":"2019","journal-title":"N Engl J Med"},{"key":"2025030423590592500_ezaf054-B26","first-page":"304","article-title":"The carbon footprint of treating patients with septic shock in the intensive care unit","volume":"20","author":"McGain","year":"2018","journal-title":"Crit Care Resusc"},{"key":"2025030423590592500_ezaf054-B27","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1007\/s11367-021-01998-8","article-title":"Environmental footprint of regular and intensive inpatient care in a large US hospital","volume":"27","author":"Prasad","year":"2022","journal-title":"Int J Life Cycle Assess"},{"key":"2025030423590592500_ezaf054-B28","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1177\/08404704241259652","article-title":"Bioplastics: no solution to healthcare\u2019s plastic pollution problem","volume":"37","author":"Yu","year":"2024","journal-title":"Healthc Manage Forum"},{"key":"2025030423590592500_ezaf054-B29","volume-title":"LCA Herbruikbare en Eenmalige Ok-Jassen en Afdekmateriaal","author":"Bijleveld","year":"2022"},{"key":"2025030423590592500_ezaf054-B30","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1213\/ANE.0b013e31824d9cc3","article-title":"A comparison of reusable and disposable perioperative textiles: sustainability state-of-the-art 2012","volume":"114","author":"Overcash","year":"2012","journal-title":"Anesth Analg"},{"key":"2025030423590592500_ezaf054-B31","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1177\/01410768231166135","article-title":"The carbon footprint of products used in five common surgical operations: identifying contributing products and processes","volume":"116","author":"Rizan","year":"2023","journal-title":"J R Soc Med"},{"key":"2025030423590592500_ezaf054-B32","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.jhin.2022.07.011","article-title":"The carbon footprint of the operating room related to infection prevention measures: a scoping review","volume":"128","author":"Bolten","year":"2022","journal-title":"J Hosp Infect"},{"key":"2025030423590592500_ezaf054-B33","first-page":"CD006353","article-title":"Use of plastic adhesive drapes during surgery for preventing surgical site infection","volume":"2015","author":"Webster","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"2025030423590592500_ezaf054-B34","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1161\/CIRCULATIONAHA.116.021933","article-title":"Long-term survival and freedom from reintervention after off-pump coronary artery bypass grafting: a propensity-matched study","volume":"134","author":"Kirmani","year":"2016","journal-title":"Circulation"},{"key":"2025030423590592500_ezaf054-B35","first-page":"4263","article-title":"Comparative efficacy on outcomes of C-CABG, OPCAB, and ONBEAT in coronary heart disease: a systematic review and network meta-analysis of randomized controlled trials","volume":"109","author":"Zhu","year":"2023","journal-title":"Int J Surg"},{"key":"2025030423590592500_ezaf054-B36","author":"Loomans","year":"2022"},{"key":"2025030423590592500_ezaf054-B37","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.jhin.2024.03.008","article-title":"Effect of unidirectional airflow ventilation on surgical site infection in cardiac surgery: environmental impact as a factor in the choice for turbulent mixed air flow","volume":"148","author":"Friedericy","year":"2024","journal-title":"J Hosp Infect"},{"key":"2025030423590592500_ezaf054-B38","doi-asserted-by":"crossref","first-page":"7117","DOI":"10.3390\/en15197117","article-title":"Sustainable savings applied to operating room ventilation at hospitals located in different climatic zones, through control and regulation strategies","volume":"15","author":"Castellanos-Antol\u00edn","year":"2022","journal-title":"Energies"},{"key":"2025030423590592500_ezaf054-B39","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1093\/bjs\/znab406","article-title":"Minimising carbon and financial costs of steam sterilisation and packaging of reusable surgical instruments","volume":"109","author":"Rizan","year":"2022","journal-title":"Br J Surg"},{"key":"2025030423590592500_ezaf054-B40","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1093\/europace\/euac160","article-title":"Carbon footprint of atrial fibrillation catheter ablation","volume":"25","author":"Ditac","year":"2023","journal-title":"Europace"},{"key":"2025030423590592500_ezaf054-B41","first-page":"e48297","article-title":"Percutaneous coronary intervention vs. coronary artery bypass grafting in left main coronary artery disease: an updated systematic review and meta-analysis","volume":"15","author":"Hennessy","year":"2023","journal-title":"Cureus"},{"key":"2025030423590592500_ezaf054-B42","doi-asserted-by":"crossref","first-page":"e035174","DOI":"10.1136\/bmjopen-2019-035174","article-title":"Analysing actual prices of medical products: a cross-sectional survey of Dutch hospitals","volume":"10","author":"den Ambtman","year":"2020","journal-title":"BMJ Open"},{"key":"2025030423590592500_ezaf054-B43","doi-asserted-by":"crossref","first-page":"e046917","DOI":"10.1136\/bmjopen-2020-046917","article-title":"Determinants of drug prices: a systematic review of comparison studies","volume":"11","author":"Janssen Daalen","year":"2021","journal-title":"BMJ Open"},{"key":"2025030423590592500_ezaf054-B44","doi-asserted-by":"crossref","first-page":"e25","DOI":"10.1017\/S0266462324000230","article-title":"Health technology assessment and healthcare environmental sustainability: prioritizing effort and maximizing impact","volume":"40","author":"Hensher","year":"2024","journal-title":"Int J Technol Assess Health Care"},{"key":"2025030423590592500_ezaf054-B45","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1016\/j.jval.2024.02.019","article-title":"Methods to include environmental impacts in health economic evaluations and health technology assessments: a scoping review","volume":"27","author":"Williams","year":"2024","journal-title":"Value Health"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ejcts\/advance-article-pdf\/doi\/10.1093\/ejcts\/ezaf054\/61932852\/ezaf054.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/67\/2\/ezaf054\/61932852\/ezaf054.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/67\/2\/ezaf054\/61932852\/ezaf054.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T18:59:26Z","timestamp":1741114766000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/doi\/10.1093\/ejcts\/ezaf054\/8019663"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2]]},"references-count":45,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,2,4]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezaf054","relation":{},"ISSN":["1873-734X"],"issn-type":[{"value":"1873-734X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,2]]},"published":{"date-parts":[[2025,2]]},"article-number":"ezaf054"}}