{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T18:56:03Z","timestamp":1790016963156,"version":"4.0.1"},"reference-count":24,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2023,5,24]],"date-time":"2023-05-24T00:00:00Z","timestamp":1684886400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Hand Surg Eur Vol"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:p>\n                    The primary aim of our study was to assess the environmental impact of moving from a standard to a lean and green model for a carpal tunnel decompression. We objectively measured the clinical waste generated, the number of single use items and the number of sterile instruments required for a standard procedure, and then moved to smaller instrument trays, smaller drapes and fewer disposables. These two models were compared for waste generation, financial costs and carbon footprint. Information prospectively collected on seven patients in the standard model and 103 patients in the lean and green model in two hospitals over a 15-month period, demonstrated a reduction in CO\n                    <jats:sub>2<\/jats:sub>\n                    emissions of 80%, clinical waste reduction of 65%, and an average aggregate cost saving of 66%. The lean and green model can deliver a safe, efficient, cost-effective and sustainable service for patients undergoing carpal tunnel decompression.\n                  <\/jats:p>\n                  <jats:p>Level of evidence: III<\/jats:p>","DOI":"10.1177\/17531934231176952","type":"journal-article","created":{"date-parts":[[2023,5,25]],"date-time":"2023-05-25T02:53:42Z","timestamp":1684983222000},"page":"1022-1029","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":21,"title":["Reducing the carbon footprint in carpal tunnel surgery inside the operating room with a lean and green model: a comparative study"],"prefix":"10.1177","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2098-4409","authenticated-orcid":false,"given":"Preetham","family":"Kodumuri","sequence":"first","affiliation":[{"name":"Wrexham Maelor Hospital, Wrexham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edwin Prash","family":"Jesudason","sequence":"additional","affiliation":[{"name":"Ysbyty Gwynedd, Bangor, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivien","family":"Lees","sequence":"additional","affiliation":[{"name":"Manchester University Foundation Trust, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,5,24]]},"reference":[{"key":"bibr1-17531934231176952","unstructured":"ARUP. 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