Life cycle assessment and life cycle cost of repairing surgical scissors

Purpose The primary objective of this study was to evaluate the environmental impact and financial cost of repairing surgical scissors. Methods We used life cycle assessment (LCA) and life cycle cost analysis to estimate environmental impacts and financial cost of repairing surgical scissors. The functional unit was one use of a reusable surgical scissor (manufactured in Germany and used in the UK), and three baseline scenarios were compared: no repair, onsite (hospital), and offsite (external contract) repair. This 'cradle-to-grave' analysis included raw material extraction, manufacture of scissors and materials within primary and secondary packaging, transportation, decontamination, repair (where relevant), and waste disposal. Primary activity data was sourced from the instrument manufacturer, supplier, and from UK repair centres (both onsite and offsite), whilst the Ecoinvent database was used as a secondary data source for the manufacture of scissors. The World ReCiPe Midpoint and Endpoint Hierarchist method (Version 1.1) was used for environmental impact assessment. Scenario analysis was used to evaluate the impact of altering different assumptions, including number of uses, reducing number of repairs, increasing distance to offsite repair centre, and alternative electricity sources and waste handling processes. Life cycle cost analysis was calculated based on purchase cost, and cost of decontamination, repair, and waste disposal. Results and discussion The carbon footprint of reusable scissors was 70 g CO 2 e per use, assuming scissors were used 40 times before replacement. This was reduced by 19% through use of offsite repair every 40 uses (57 g CO 2 e/scissor use), with small additional reductions associated with onsite repair (56 g CO 2 e/scissor use). Similar patterns of reduction were calculated for eighteen midpoint environmental impact categories (mean impact reduction of 30% for those repaired offsite relative to no repair) and also across three endpoint categories. Decontamination made the biggest contribution to the carbon footprint across all baseline scenarios (76% where no repair, 95-97% where repaired offsite and onsite respectively). Findings were robust to alternative scenario analyses. Life cycle cost was GBP 1.43 pound per use of reusable scissors, and when repaired either on- or offsite this decreased by 32% to GBP 0.97 pound per use. Conclusion Repairing surgical scissors rather than replacing them with a new pair can reduce environmental and financial cost. The extent to which repair may play a role in mitigating the environmental impact of other surgical instruments requires further research.