The Neptune 3 drainage system is developed as an alternative to canister systems for collecting surgical fluids in the operating room. This study investigates the difference in the environmental impact between Neptune 3 and canister systems, evaluating all individual stages of the product life cycle of the Neptune and canisters. Using the RECIPE model, 17 impact categories (midpoints) were defined and results were aggregated into three endpoint categories (human health, ecosystems, resources). The volume of waste was varied in a setup in a hospital in the Netherlands and included different fluid volume collection scenarios performed over seven years: high-volume (2.0–24 L waste) and low-volume (0.1–0.5 L waste). In both high and low volume procedures, Neptune 3 has a lower environmental impact compared to canisters for global warming (15–89% reduction), ozone formation terrestrial ecosystems & human health (24–91% reduction), fossil resource scarcity (36–92% reduction) and water consumption (44–106% reduction). In high volume scenarios (5 + Liters) Neptune also has a lower impact in stratospheric ozone depletion, fine particulate matter formation, terrestrial acidification for the high volume scenarios (5 L or more). In the case of ionizing radiation, freshwater eutrophication, and human carcinogenic toxicity the Neptune has a lower impact only in the very large volume procedures (10 + Liter). By aggregating the mid-point results to end-point results, it is observed that the Neptune system is beneficial for resources in each scenario, and for human health and ecosystems for procedures with larger volumes. Results from this LCA demonstrate that the Neptune 3 system is environmentally beneficial compared to canisters. This study provides valuable information for policymakers and hospital decisionmakers to treat their surgical waste in an environmentally friendly way.

In de afgelopen decennia is het aantal medische wegwerpproducten significant toegenomen. Binnen het bedrijf GreenCycl en het GreenCycl Fieldlab worden oplossingen gezocht om de schaarste van grondstoffen tegen te gaan. Diverse methoden zijn onderzocht om medisch afval na gebruik opnieuw in te zetten als product, instrumentonderdelen of grondstof. De methoden volgen de strategieën van de Butterfly Diagram van de Ellen MacArthur Foundation. Een mix van deze strategieën is onderzocht en toegepast op vijf afvalstromen van de operatiekamer: complexe endoscopische instrumenten, herbruikbare instrumenten van roestvast staal, wegwerpinstrumenten van roestvast staal, instrumenten met inpakpapier van polypropyleen (PP) en verpakkingsmateriaal van polyethyleentereftalaat (PET). De vijf afvalstromen hebben hun eigen specifieke verwerkingsproces en verschillen in de benodigde hoeveelheid energie. Alle strategieën verminderen de CO2-uitstoot met 2,2-3 kg CO2 per kg afval. In alle gevallen blijkt het materiaal zijn eigenschappen grotendeels te behouden. Dit maakt de circulaire strategieën toepasbaar voor elk ziekenhuis.

Introduction: Given increasing numbers of breast cancer survivors, there is an increased focus on quality of life and quality of care. This study aims to investigate whether clinical or patient reported outcomes are most important for perceived quality of care by breast cancer patients. Methods: Overall, 606 patients aged 18 years or older, who underwent breast cancer surgery 9-18 months ago in five hospitals in the Netherlands, were invited to complete an internet-based questionnaire. Patients were asked to judge a random selection of 24 patient profiles and choose which of 2 presented patients had received the best quality of care, using conjoint analysis. The individual relative importance (RI) for each outcome was estimated using Hierarchical Bayes Estimation, and averaged over all patients to assess which outcomes were most important. Results: Complete data were available for 350 patients (58%). Avoiding severe breast symptoms was most important for good quality of care according to patients (RI 23.22 [95% Confidence Interval (95% CI) 22.32-24.12]), followed by a 2 year longer disease free survival (18.30 [17.38-19.22]). However, the importance differed by age: younger patients (<50 years) assigned higher importance to longer disease free survival (21.99 [19.52-24.46]) than older patients (65 + years) (15.03 [13.88-16.18]). Conclusion: Avoiding severe breast symptoms rather than 2 year longer disease free survival is considered most important in our population of breast cancer patients for evaluation of quality of care. These data should thus be included in both information provision prior to treatment choices and post treatment quality of care evaluation.