{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T08:06:58Z","timestamp":1784275618450,"version":"3.55.0"},"reference-count":31,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T00:00:00Z","timestamp":1755561600000},"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":["Shoulder &amp; Elbow"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The United Kingdom National Health Service is responsible for a vast carbon footprint, with annual carbon dioxide emissions at over 25 million tonnes. Operating theatres contribute up to 25% of a hospital's emissions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To rationalise the composition of the single-use convenience packs in arthroscopic and open shoulder surgery, to reduce the annual carbon footprint.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The individual material composition of all items in the single-use shoulder arthroscopy and open shoulder convenience packs was considered. The carbon footprint of each item was calculated by the application of best available cradle-to-gate emission factors. The items in the packs were then rationalised by consensus (of surgeons and scrub team). Two new standardised packs were designed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the 2022\/2023 financial year, 296 arthroscopic and 191 open shoulder procedures were performed. The new rationalised open packs had between 3 and 18 fewer items, the new arthroscopic packs 7\u20138 fewer items. This will result in reduction of 108.9\u2005kg of single use plastics, and an overall annual carbon footprint reduction of 643.8\u2005kgCO\n                      <jats:sub>2<\/jats:sub>\n                      <jats:sup>e<\/jats:sup>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Through a simple method of single-use convenience pack rationalisation, we have reduced the annual carbon footprint of shoulder surgery at our institution. The same methodology is being applied to all orthopaedic packs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17585732251364390","type":"journal-article","created":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T07:15:23Z","timestamp":1755587723000},"page":"774-782","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Carbon footprint reduction in shoulder surgery by the rationalisation of single-use convenience packs"],"prefix":"10.1177","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0403-3454","authenticated-orcid":false,"given":"Alex","family":"Chowdhury","sequence":"first","affiliation":[{"name":"Department of Trauma and Orthopaedics, Hampshire Hospitals Foundation Trust, Winchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Hillier-Smith","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopaedics, Hampshire Hospitals Foundation Trust, Winchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Imran","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopaedics, Hampshire Hospitals Foundation Trust, Winchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rabia","family":"Iqbal","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopaedics, Hampshire Hospitals Foundation Trust, Winchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry B","family":"Cola\u00e7o","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopaedics, Hampshire Hospitals Foundation Trust, Winchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,8,19]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2542-5196(20)30271-0"},{"key":"e_1_3_3_3_2","unstructured":"Health Care Without Harm. 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