Climate hazards are associated with health disparities, creating vicious cycles that disproportionately impact marginalised groups [1]. There is increasing interest in healthcare sustainability, including in anaesthesia, with the National Health Service (NHS) committed to ‘net zero’ carbon emissions by 2040. Peri-operative healthcare sustainability interventions can broadly be divided into four categories [2]. First, and most impactful, is disease prevention. Second is patient empowerment interventions, including surgical prehabilitation. Third, moving healthcare towards lean-care systems, avoiding wasteful practices. Finally, doctors can switch to low-carbon alternatives, such as reusable instruments.

We describe the results of a rapid review, where we considered what types of publications related to environmental sustainability are being published in anaesthesia journals, and to what extent these sustainability publications consider health inequity. The full, pre-registered methodology has been published previously [3].

Briefly, we conducted a literature search in PubMed on 31/01/2024, focusing on English language articles in anaesthesia journals listed in the InCites Journal Citation Reports (N = 65), using a broad query string with terms related to climate change; greenhouse gases; and sustainability (Mesh terms included). After screening, we extracted information about primary outcomes; categories of interventions mentioned (prevention, patient empowerment, lean-care systems and low-carbon alternatives); first-author affiliated institution location and its World Bank income region; and text relating to inequality, inequity, or climate justice. We defined health inequality as a difference in measurable health outcomes between individuals or groups; health inequity as a specific type of health inequality that is preventable, unnecessary and unjust; and climate justice as the approach that recognises inequities and designs interventions to correct them. After extraction, we used custom Python 3.8 code to extract descriptive statistics and a word cloud generator to analyse climate justice text (available in online Supporting Information Figure S1).

We identified 199 publications on sustainability in 27/51 (53%) PubMed-indexed journals (online Supporting Information Table S1). Most sustainability publications (175/199, 88%) were in ten journals, and 80/199 (40%) of publications presented original research. Most publications (177/199, 89%) focused on low-carbon alternatives, 66/199 (33%) discussed ‘lean-care systems’, 11/199 (6%) discussed patient empowerment; and 6/199 (3%) discussed disease prevention. Visualised within the ‘Pyramid of Impact’ (Fig. 1), the focus was mostly on in-theatre mitigation. Patient empowerment interventions included broadening the anaesthetic consent process to include information and choices about environmental impact; more patient education and engagement; using patient-reported outcomes; and including patient representatives in research and policy meetings. Disease prevention interventions included prehabilitation; broadening pre- and postoperative clinics towards preventative management; ‘getting it right first time’ principles (GIRFT); and supporting active transport in patients. No studies quantified the environmental impact of these interventions.

Most sustainability publications (194/199, 98%) had first authors affiliated with high-income country institutions. Article type distribution varied between countries and journals, with Anaesthesia having the largest proportion of articles discussing patient empowerment (5/29, 17.2%). All articles discussing patient empowerment or disease prevention were from 2019 onwards. Few publications (32/199, 16%) had text relating to inequality or inequity, and none met our definition as talking about climate justice. Such discussions focussed predominantly on inequality, and mostly on between-country differences. Inequality was mentioned largely to indicate relevance of studying sustainability or as a limitation of generalisability. No original research related study findings to their impact on inequality or inequity.

Our work highlights a disproportionate focus on in-theatre mitigation. Some of this work has been highly impactful, e.g. the UK Nitrous Oxide Project. However, prevention and empowerment have been suggested as the most impactful categories of reducing peri-operative environmental impact [4, 5]; we need more original research to substantiate this [6, 7]. Several interventions are ripe for testing, including prehabilitation; broadening shared decision making to include environmental information; and redefining peri-operative care to encompass prevention. Limitations of our work include only using one database and publications in English.

Anaesthetists are often already working on these interventions. Crucially, however, they are not being recognised or tested for their environmental benefits. In our view, lack of equity consideration is also a missed opportunity. Researchers looking to conduct clinical interventional studies in sustainability should proactively centre equity, e.g. by using PROGRESS-Plus [8]. Climate change worsens health inequities; considering them in isolation risks failing to address either effectively.

气候灾害与健康差异有关，造成恶性循环，对边缘化群体的影响尤为严重 [1]。人们对医疗保健可持续性的兴趣日益浓厚，包括麻醉，英国国家医疗服务体系 （NHS） 承诺到 2040 年实现“净零”碳排放。围手术期医疗保健可持续性干预大致可分为四类 [2]。首先，也是最具影响力的，是疾病预防。其次是患者赋权干预，包括手术预康复。第三，将医疗保健转向精益护理系统，避免浪费的做法。最后，医生可以改用低碳替代品，例如可重复使用的器械。

我们描述了一项快速综述的结果，其中我们考虑了麻醉期刊上发表了哪些类型的与环境可持续性相关的出版物，以及这些可持续性出版物在多大程度上考虑了健康不平等。完整的预注册方法之前已发布 [3]。

简而言之，我们于 2024 年 1 月 31 日在 PubMed 中进行了文献检索，重点关注 InCites 期刊引文报告中列出的麻醉期刊中的英文文章 （n = 65），使用带有与气候变化相关术语的广泛查询字符串;温室气体;和可持续性（包括 Mesh 术语）。筛选后，我们提取了有关主要结局的信息;提到的干预措施类别（预防、患者赋权、精益护理系统和低碳替代方案）;第一作者附属机构所在地及其世界银行收入地区;以及与不平等、不平等或气候正义相关的文本。我们将健康不平等定义为个人或群体之间可衡量健康结果的差异;健康不平等是一种特定类型的健康不平等，是可预防的、不必要和不公正的;以及气候正义作为识别不平等并设计干预措施来纠正它们的方法。提取后，我们使用自定义 Python 3.8 代码来提取描述性统计数据，并使用词云生成器来分析气候正义文本（可在在线支持信息图 S1 中找到）。

我们在 27/51 （53%） 的 PubMed 索引期刊中确定了 199 篇关于可持续性的出版物（在线支持信息表 S1）。大多数可持续发展出版物 （175/199， 88%） 发表在 10 种期刊上，80/199 （40%） 的出版物发表了原创研究。大多数出版物 （177/199， 89%） 关注低碳替代方案，66/199 （33%） 讨论了“精益护理系统”，11/199 （6%） 讨论了患者赋权;6/199 （3%） 讨论了疾病预防。在“影响金字塔”（图 1）中可视化，重点主要集中在手术室内缓解上。患者赋权干预措施包括扩大麻醉同意流程，以包括有关环境影响的信息和选择;更多的患者教育和参与;使用患者报告的结果;以及让患者代表参加研究和政策会议。疾病预防干预措施包括康复前;扩大术前和术后诊所的预防性管理;“一次就做对”原则 （GIRFT）;并支持患者的主动运输。没有研究量化这些干预措施对环境的影响。

大多数可持续发展出版物 （194/199， 98%） 的第一作者隶属于高收入国家机构。文章类型分布因国家和期刊而异，其中 Anaesthesia 在讨论患者赋权的文章中占比最大 （5/29， 17.2%）。所有讨论患者赋权或疾病预防的文章都是从 2019 年开始的。很少有出版物（32/199,16%）有与不平等或不公平相关的文本，也没有一个符合我们关于谈论气候正义的定义。此类讨论主要集中在不平等问题上，而且主要关注国家间的差异。提到不平等主要是为了表明研究可持续性的相关性或作为普遍性的局限性。没有关于它们对不平等或不公平影响的原始研究相关研究结果。

我们的工作突出了对手术室内缓解的不成比例的关注。其中一些工作产生了很大的影响，例如英国一氧化二氮项目。然而，预防和赋权被认为是减少围手术期环境影响的最有效类别 [4， 5];我们需要更多的原创研究来证实这一点 [6， 7]。几种干预措施的测试已经成熟，包括预康复;扩大共同决策范围，将环境信息纳入其中;并重新定义围手术期护理以包括预防。我们工作的局限性包括仅使用一个数据库和英文出版物。

麻醉师通常已经在研究这些干预措施。然而，至关重要的是，它们的环境效益没有得到认可或测试。我们认为，缺乏股权对价也是错失良机。希望进行可持续性临床干预研究的研究人员应积极以公平为中心，例如使用 PROGRESS-Plus [8]。气候变化加剧了健康不平等;孤立地考虑它们可能会有效地解决这两个问题。