Table_1_Healthcare-related carbon footprinting—lower impact of a coronary stenting compared to a coronary surgery pathway.pdf

Healthcare is a major generator of greenhouse gases, so consideration of this contribution to climate change needs to be quantified in ways that can inform models of care. Given the availability of activity-based financial data, environmentally-extended input–output (EEIO) analysis can be employed to calculate systemic carbon footprints for healthcare activities, allowing comparison of different patient care pathways. We thus quantified and compared the carbon footprint of two common care pathways for patients with stable coronary artery disease, with similar clinical outcomes: coronary stenting and coronary artery bypass surgery (CABG). Healthcare cost data for these two pathways were disaggregated and the carbon footprint associated with this expenditure was calculated by connecting the flow of money within the economy to the greenhouse gases emitted to support the full range of associated activities. The systemic carbon footprint associated with an average stable patient CABG pathway, at a large tertiary referral hospital in Sydney, Australia in 2021–22, was 11.5 tonnes CO2-e, 4.9 times greater than the 2.4 tonnes CO2-e footprint of an average comparable stenting pathway. These data suggest that a stenting pathway for stable coronary disease should be preferred on environmental grounds and introduces EEIO analysis as a practical tool to assist in health-care related carbon footprinting.

医疗保健行业是温室气体的主要排放源之一，因此有必要通过可指导医疗照护模型构建的方式，量化其对气候变化的影响贡献。鉴于基于活动的财务数据已可获取，可采用环境扩展投入产出（environmentally-extended input–output, EEIO）分析法，计算医疗相关活动的全系统碳足迹，进而实现不同患者照护路径的对比分析。据此，我们针对临床结局相似的两类稳定型冠状动脉疾病患者常用照护路径——冠状动脉支架植入术与冠状动脉旁路移植术（coronary artery bypass surgery, CABG）——的碳足迹进行了量化与对比。我们对这两类照护路径的医疗成本数据进行了拆解，并通过将经济体内部的资金流动与支撑各类相关活动所排放的温室气体进行关联，计算得到该支出对应的碳足迹。2021至2022年，澳大利亚悉尼某大型三级转诊医院中，单例稳定型冠心病患者接受CABG路径的全系统碳足迹为11.5吨二氧化碳当量（CO2-e），是同类支架植入路径（单例碳足迹2.4吨二氧化碳当量）的4.9倍。上述数据表明，从环境可持续性角度出发，稳定型冠心病患者应优先选择支架植入照护路径；同时本研究验证了EEIO分析法可作为实用工具，辅助开展医疗相关碳足迹核算工作。