Improving day case rates for bladder tumour surgery could help reduce NHS carbon footprint, study shows

Increasing day case rates for bladder tumour surgery has the potential to significantly reduce carbon emissions and help the NHS achieve its ambition of net zero by the year 2040, according to a new study published in a European journal.

In a collaboration between NHS England’s Getting It Right First Time (GIRFT) and Greener NHS programmes, the study demonstrates a trend towards more day surgery for the urological procedure transurethral resection of bladder tumour (TURBT – the ‘gold-standard’ operation used to treat patients with bladder cancer), from 13% of all TURBT operations in England performed as day-case in 2013/14 to 31% in 2021/22.

While offering the same high standard of care for patients, TURBT day surgery offers a lower carbon footprint than the same surgery performed during an inpatient stay*, meaning the total estimated carbon saving of the year-on-year increase in day-case rates equates to 2.9 million Kg CO2e – enough to power 2,716 homes for a year.

The study concludes that reducing existing variation in day case rates between trusts could further reduce carbon emissions; for example, there was the potential for carbon savings of 217,599 Kg CO2e in the financial year 2021/22 – the equivalent of enough power for 198 homes for a year – if all NHS trusts had met the day case rates for TURBT being achieved by the top 25% of trusts**.

Potential carbon savings with day-case compared to inpatient transurethral resection of bladder tumour surgery in England is published in May 2023 in European Urology Open Science.

Contributing around 4% of England’s emissions, the NHS is both a part of the problem and the solution when it comes to climate change. In October 2020, it became the world’s first health system to commit to reaching net zero emissions by 2040 for directly controlled emissions; and by 2045 for emissions that the NHS influences.

Although not appropriate for all patients, day case surgery is generally more efficient and a more environmentally sustainable model of care than an in-patient stay. Increasing day case surgery rates may also help to reduce waiting lists for elective care. 

GIRFT’s 2018 national report for urology identified that day-case rates for TURBT varied substantially across NHS trusts and recommended that rates be increased so that all providers meet the performance of the best-performing 25%. There has been subsequent published evidence to suggest that day-case TURBT is safe and that day-case rates are increasing.

The GIRFT urology workstream is piloting work to assess the carbon impact of various urology pathways developed via GIRFT, such as those for male bladder outflow surgery and acute urinary tract stones. It is hoped the work will eventually translate to other specialties and pathways within the GIRFT programme, to support the NHS England target of being net-zero for carbon emissions by 2040.


*A separate study attributed 42.3% of the carbon footprint of surgical care to anaesthetic gases, 23% to the surgical procedure itself, and 5.5% to patient travel – these figures remain largely the same regardless of surgical setting. However, 29.2% of the carbon footprint was attributed to in-patient bed days (created by such factors as staff travel, disposables, laundry, sterilisation of equipment, heating, lighting etc) and it is this figure which can be reduced by increasing rates of day-case surgery.

**It is important to note that carbon savings identified in the study are savings per patient, rather than a direct reduction in emissions. At the current time, the bed capacity released by increasing day-case surgery will be taken up by other patients, rather than resulting in reduced hospital activity. Carbon savings can only be achieved when supply matches or exceeds demand.

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