Sustainability assessment of perioperative patient warming devices: a comparative life cycle assessment and costing.

BACKGROUND: Perioperative patient warming is an integral component of quality surgical care, subject to highly variable clinical practices. We evaluated the environmental and economic impacts of currently available patient warming methods. METHODS: We conducted a comparative life cycle assessment (LCA) and life cycle costing (LCC) of three active warming devices (forced air warmer, resistive blanket, and circulating water garment) using a functional unit of 1 h of active patient warming. Passive warming was investigated using a singular LCA and LCC of warmed flannel blankets, with the functional unit defined as the use of one warmed flannel blanket. These results were applied to eight clinical scenarios modelling different combinations of warming devices within perioperative settings. We used multicriteria decision analysis to aggregate environmental and financial impacts into sustainability indexes. RESULTS: The resistive blanket had the lowest environmental and economic impacts. The global warming potential and cumulative energy demand of the resistive blanket were <7% and 25%, respectively, of the impacts assessed for the forced air warmer. The most sustainable patient warming pathway used the resistive blanket throughout the perioperative period. Clinical scenarios using flannel blankets before and after surgery entailed the highest environmental impacts, and the highest cost was incurred with the circulating water garment. CONCLUSIONS: The environmental and economic sustainability of perioperative patient warming can be optimised by minimising flannel blankets and disposable consumables in the perioperative period and by using the resistive blanket for active warming. This study presents a novel multicriteria sustainability index and simulates clinically relevant scenarios to inform practical, evidence-based recommendations for sustainable patient warming.