{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T20:26:54Z","timestamp":1790800014367,"version":"4.1.0"},"reference-count":81,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Surgical care significantly contributes to greenhouse gas emissions, with operating rooms consuming three to six times more energy than other departments relying heavily on single-use materials and anaesthetic gases. We conducted a systematic review of literature from 2023 to 2025 following PRISMA guidelines. The PubMed, Scopus and Healthcare LCA databases were searched, and eligibility criteria were applied. A total of 26 studies met inclusion criteria. Data were extracted on each study\u2019s scope and system boundaries, reported emission values, identified carbon hotspots, and any mitigation strategies evaluated. A structured quality assessment was conducted to evaluate the reliability of the included studies and to identify potential sources of bias. The included studies demonstrated wide variability in reported carbon footprints of surgery, ranging from under 5 kgCO\u2082e for minor procedures to over over 400 kgCO\u2082e for complex single-stage operations and approximately 1,000 kgCO\u2082e for whole multistage patient pathways. This systematic review underscores that surgical operations could have a significant carbon footprint, with emissions hotspots concentrated in consumable materials and energy consumption. It also reveals substantial variability and methodological heterogeneity in how surgical carbon footprints are calculated, pointing to the urgent need for standardized life-cycle based frameworks in surgical settings. Establishing common standards will enable more reliable benchmarking of surgical emissions and better comparisons across studies.<\/jats:p>","DOI":"10.1371\/journal.pone.0349415","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T17:26:02Z","timestamp":1779125162000},"page":"e0349415","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["The carbon footprint of surgical operations: 2023\u20132025 systematic review update"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-2672-4130","authenticated-orcid":true,"given":"Anna","family":"Savio","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Marchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0271-5638","authenticated-orcid":true,"given":"Andrea","family":"Roletto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierangelo","family":"Guizzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Milano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0419-643X","authenticated-orcid":true,"given":"Lucio Enrico","family":"Zavanella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Zanoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"issue":"2","key":"pone.0349415.ref001","article-title":"Health care\u2019s response to climate change: a carbon footprint assessment of the NHS in England","volume":"5","author":"I Tennison","year":"2021","journal-title":"Lancet Planet Health"},{"key":"pone.0349415.ref002","article-title":"Perspective chapter: Climate change and health inequities","author":"S Johnson","year":"2024","journal-title":"Health inequality - A comprehensive exploration. 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