Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/35058
Title: Environmental and financial impacts of perioperative paracetamol use: a multicentre international life-cycle analysis.
Austin Authors: Davies, Jessica F;McAlister, Scott;Eckelman, Matthew J;McGain, Forbes;Seglenieks, Richard;Gutman, Elena N;Groome, Jonathan;Palipane, Natasha;Latoff, Katherine;Nielsen, Dominic;Sherman, Jodi D
Affiliation: Anaesthesia
Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia.
Department of Civil & Environmental Engineering, Northeastern University, Boston, MA, USA.
Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia; Sydney School of Public Health, University of Sydney, Centre for Health Policy, University of Melbourne, Melbourne, VIC, Australia; Department of Anaesthesia and Pain Medicine, Western Health, Footscray, VIC, Australia.
Department of Anaesthesia and Pain Medicine, Western Health, Footscray, VIC, Australia; Department of Anaesthesia, Grampians Health, Ballarat, VIC, Australia.
Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA.
Barts Health NHS Trust, London, UK; Nuffield Health, London, UK.
University College London Hospitals NHS Foundation Trust, London, UK.
Department of Civil & Environmental Engineering, Northeastern University, Boston, MA, USA.
Greener Anaesthesia & Sustainability Project (GASP), London, UK.
Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA; Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA.
Issue Date: 30-Jan-2024
Date: 2024
Publication information: British Journal of Anaesthesia 2024-01-30
Abstract: Pharmaceuticals account for 19-32% of healthcare greenhouse gas (GHG) emissions. Paracetamol is a common perioperative analgesic agent. We estimated GHG emissions associated with i.v. and oral formulations of paracetamol used in the perioperative period. Life-cycle assessment of GHG emissions (expressed as carbon dioxide equivalents CO2e) of i.v. and oral paracetamol preparations was performed. Perioperative paracetamol prescribing practices and costs for 26 hospitals in USA, UK, and Australia were retrospectively audited. For those surgical patients for whom oral formulations were indicated, CO2e and costs of actual prescribing practices for i.v. or oral doses were compared with optimal oral prescribing. The carbon footprint for a 1 g dose was 38 g CO2e (oral tablet), 151 g CO2e (oral liquid), and 310-628 g CO2e (i.v. dependent on type of packaging and administration supplies). Of the eligible USA patients, 37% received paracetamol (67% was i.v.). Of the eligible UK patients, 85% received paracetamol (80% was i.v.). Of the eligible Australian patients, 66% received paracetamol (70% was i.v.). If the emissions mitigation opportunity from substituting oral tablets for i.v. paracetamol is extrapolated to USA, UK, and Australia elective surgical encounters in 2019, ∼5.7 kt CO2e could have been avoided and would save 98.3% of financial costs. Intravenous paracetamol has 12-fold greater life-cycle carbon emissions than the oral tablet form. Glass vials have higher greenhouse gas emissions than plastic vials. Intravenous administration should be reserved for cases in which oral formulations are not feasible.
URI: https://ahro.austin.org.au/austinjspui/handle/1/35058
DOI: 10.1016/j.bja.2023.11.053
ORCID: 
Journal: British Journal of Anaesthesia
PubMed URL: 38296752
ISSN: 1471-6771
Type: Journal Article
Subjects: environment
life-cycle assessment
paracetamol
perioperative medicine
pharmaceuticals
Appears in Collections:Journal articles

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