Healthcare is one of the largest waste-generating activities contributing to climate change, with surgery the most energy-intense sector. This international survey aimed to evaluate current understanding and perspectives of colorectal surgeons on sustainability, with a specific focus on surgical practice.


The European Society of Coloproctology (ESCP) designed an online survey – ECOS-Surgery (ESCP Collecting Opinions on Sustainable Surgery). Questions were divided into three sections to capture demographic characteristics of participants, their awareness on global sustainability with its application to surgical practice, and their perspectives on future directions in sustainability.


370 participants from 57 countries answered the survey (median age 39; 75% men; 73% consultant surgeons). Around 60% of them were unaware that the health sector contributed to global greenhouse gas emissions. Delivering sustainable surgery was perceived as a matter of great importance for most (92%), and 97% of participants were willing to change their practice to improve sustainability. However, 78% of them had no local or national guidance on this subject. Lack of understanding by the surgical community was recognised as the primary key barrier in improving sustainable pathways (63%). Research in sustainability was perceived to play a role in improving sustainability in surgery by the majority (97.5%). Promoting healthy lifestyle among patients (38%) and use of low-carbon alternatives in surgery (29%) were the solutions most commonly suggested.


Our survey shows the surgical community’s interest in supporting a sustainable surgery pathway, although underlining the lack of contemporary guidance/support to achieve this goal. . .

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