Environmental Implications of Discretionary Single-Use Devices in Sleeve Gastrectomy: Exploring the Impact of Inter-Surgeon Variability in a Retrospective Pilot Study

IntroductionOperating theatres contribute disproportionately to healthcare's carbon footprint, with single-use devices (SUDs) representing a major source of waste and emissions. While life cycle assessments (LCAs) quantify product-specific impact, they are often impractical for routine use. This pilot study introduces a framework for assessing inter-surgeon variability in SUD use as a pragmatic consumption-based surrogate marker for environmental burden, offering a scalable and actionable alternative to product-level carbon foot printing.MethodA retrospective study of 125 elective laparoscopic sleeve gastrectomy (LSG) procedures performed by five bariatric surgeons was conducted. Discretionary equipment (DE) use, operative time, and length of stay (LOS) were analysed using Analysis of Means (ANOM) with 99.9% decision limits to assess inter-surgeon variability.ResultsPatient demographics were comparable across surgeons. Mean DE use ranged from 1.9-6.0 items per case, with corresponding cost variation (mean $827.40 overall), and no surgeon's mean fell within decision limits. Operative time varied across surgeons, while LOS ranged from 1.9-3.2 days. Higher discretionary device use was not associated with shorter operative times or reduced LOS.ConclusionSubstantial inter-surgeon variability in discretionary SUD use was observed within a standardised elective procedure. These findings suggest that resource consumption may be driven by individual practice patterns than clinical necessity, identifying a tangible opportunity for sustainability-focused audit and benchmarking. By adopting consumption-based procedural metrics as a practical alternative to product-level carbon foot printing, surgical teams can begin addressing environmental impact using routine workflows. Future studies incorporating complication rates and direct environmental measurements will clarify the long-term implications of lower-intensity device utilisation.