DS01 National dermatological surgery sustainability survey: an evaluation of healthcare professional beliefs and practices
Authors: Ali Fatima , Jabouri Hakam , Wernham Aaron , Abbott Rachel 
Published: June 2023

Abstract
Given the high prevalence of skin cancer in the UK, dermatological surgery contributes significantly to the environmental impact of healthcare services. To date, there are limited data evaluating current sustainability practices, attitudes and behaviours of UK health professionals involved in skin surgery. We evaluated this with a national sustainability questionnaire. An 11-item e-questionnaire was developed and pilot-tested prior to distribution. This included nested conditional branching, free-text, multiple-choice and Likert-type scale questions. The survey was distributed via professional dermatology groups to dermatological surgeons in the UK and Republic of Ireland (RoI) over 12 weeks in 2022. Qualitative data were evaluated via manual thematic analysis. Quantitative data were analysed using RStudio for descriptive statistics and SPSS for nonparametric tests (P &lt; 0.05 was considered to be statistically significant). In total, 115 healthcare professionals from 15 UK and RoI regions responded, including 67 (58.3%) consultant dermatologists/Mohs fellows, 26 (22.6%) dermatology trainees, 12 (10.4%) specialty and associate specialist dermatologists and 10 (8.7%) nurse surgeons. Single-visit provision (e.g. ‘see and treat’) for non-Mohs skin surgery was reported by 32% of overall respondents, whereas regionally, London respondents displayed a significantly higher proportion (67% vs. 25% in other UK regions; P &lt; 0.001). When working with single-use sets, 42% of respondents noted that there is at least one piece of equipment they use less than half of the time for skin surgeries, including nontoothed forceps, artery clips and skin hooks. Forty-eight per cent observed double wrapping of surgical equipment, with an additional 15% being unsure. On a seven-point Likert scale, when compared with single-use equipment, reusable equipment was perceived to outperform on safety (median 4 vs. 7; P = .006), quality (median 4 vs. 7; P &lt; 0.001) and patient outcome (median 4 vs. 7; P = 0.007); no difference was found in usability (median 7 vs. 7; P = 0.689). Perceived sustainability was greater in reusable (median 7) than in single-use (median 1) equipment (P &lt; 0.001). Almost all respondents believe global climate change is happening (97%), are concerned by the impact of dermatological surgery (74%), believe their patients have already been affected (75%), have adapted their personal/professional life accordingly (74%) and believe dermatological surgery should also take measures to reduce its impact (85%). However, only 44% feel comfortable discussing the health effects of climate change with patients. While 75% turn off surgical lighting in between lists, room lighting (31%), equipment (32%) and heating/air conditioning (22%) are often forgotten. Awareness of the impact of dermatological surgery on global climate change is high among UK dermatologists carrying out skin surgery. We encourage clinicians to translate this into local action, advocacy and service improvement to standards dictated by recently published British Society for Dermatological Surgery national sustainability guidance.