Abstract
Background:
Surgical care is resource intensive, but the environmental consequences of treatment strategies for common pediatric surgical conditions are poorly characterized. We compared environmental emissions and environmentally mediated human health impacts of operative and nonoperative management of pediatric uncomplicated appendicitis.
Study Design:
A process-based life cycle assessment compared laparoscopic appendectomy with nonoperative management using antibiotic therapy. Environmental impacts were modeled using Ecoinvent databases within CarbonGraph EcoScan and quantified with the ReCiPe 2016 method. The functional unit was 1 completed episode of care, including index treatment and downstream events over 1 year. Population-level impacts were modeled across varying rates of nonoperative management uptake.
Results:
Appendectomy generated 15.20 kg CO₂e and 5.82 × 10⁻⁵ DALYs per episode, compared with 5.98 kg CO₂e and 2.14 × 10⁻⁵ DALYs for nonoperative management including failures. Increasing nonoperative management from 20% to 50% reduced climate change impact by 20.7% and human health damage by 21.7%, corresponding to approximately 66 metric tons of CO₂e annually.
Conclusions:
For pediatric uncomplicated appendicitis, nonoperative management was associated with lower modeled greenhouse gas emissions and environmentally mediated human health damage than laparoscopic appendectomy. When clinically appropriate, greater use of nonoperative management could reduce the environmental and human health burden of care.