Critical Care, Critical Emissions: Applying life cycle assessment on intensive and perioperative care
Hemberg, Linn LU
(2026)
In Lund University, Faculty of Medicine Doctoral Dissertation Series
- Abstract
- Background. Climate change is the greatest threat to human health in the 21st century and healthcare contributes to approximately 5% of global greenhouse gas emissions. Intensive and perioperative care are particularly resource intensive. This thesis aimed to assess the climate and environmental impacts of perioperative and intensive care (Papers I–III) and to explore how environmental outcomes and associated uncertainties can be evaluated in a clinical trial context (Paper IV).
Methods. Life cycle assessment (LCA) was applied in all four papers to quantify environmental impacts across the life cycle of healthcare products and activities. Papers I and II combined LCA with life cycle costing to compare single-use, reusable, and... (More) - Background. Climate change is the greatest threat to human health in the 21st century and healthcare contributes to approximately 5% of global greenhouse gas emissions. Intensive and perioperative care are particularly resource intensive. This thesis aimed to assess the climate and environmental impacts of perioperative and intensive care (Papers I–III) and to explore how environmental outcomes and associated uncertainties can be evaluated in a clinical trial context (Paper IV).
Methods. Life cycle assessment (LCA) was applied in all four papers to quantify environmental impacts across the life cycle of healthcare products and activities. Papers I and II combined LCA with life cycle costing to compare single-use, reusable, and mixed systems for laparoscopic surgery and central venous catheter (CVC) insertions in a Swedish setting, and the impact on resource use, climate change, ecosystem quality and human health was assessed. Paper III applied LCA to estimate the total climate impact per inpatient day in a Swedish intensive care unit (ICU). In Paper IV, LCA was applied to compare the impact of an intervention and comparator in a clinical trial assessing fluid administration on 18 environmental outcomes, climate impact (kg CO₂eq) was the primary outcome. Group differences were analysed using a general linear model and a hierarchical mixed-effects model that incorporated LCA uncertainty.
Results. Reusable trocar systems and CVC insertion kits had 45–95% lower impact than the single-use alternatives on all environmental impact categories and was about half as expensive. The median climate impact of one ICU inpatient day was estimated at 30 kg CO₂eq, increasing to 126 kg CO₂eq with a high-impact energy mix. In Paper IV, results were consistent for most outcomes, with minimal differences between the statistical approaches.
Conclusions. In Sweden, replacing single-use items with reusable alternatives offers the greatest potential to reduce the climate impact of intensive and perioperative care, while renewable energy remains essential as a mitigating strategy globally. Simpler statistical approaches appear sufficient for evaluating environmental outcomes in clinical trials. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/7c5e151b-d3b7-49d4-a543-e0dc348dc14c
- author
- Hemberg, Linn
LU
- supervisor
-
- Peter Bentzer LU
- Jagdeep Singh LU
- Niklas Nielsen LU
- opponent
-
- Associate Professor Rizan, Chantelle, National University of Singapore
- organization
- publishing date
- 2026
- type
- Thesis
- publication status
- published
- subject
- keywords
- sustainable healthcare, life cycle assessment, intensive care, perioperative care, climate impact, environmental impacts
- in
- Lund University, Faculty of Medicine Doctoral Dissertation Series
- issue
- 2026:41
- pages
- 88 pages
- publisher
- Lund University, Faculty of Medicine
- defense location
- Medicinhistoriska muséet, Bergaliden 20, Helsingborg. Join by Zoom: https://lu-se.zoom.us/j/62544045240
- defense date
- 2026-03-30 09:00:00
- ISSN
- 1652-8220
- ISBN
- 978-91-8021-839-9
- language
- English
- LU publication?
- yes
- id
- 7c5e151b-d3b7-49d4-a543-e0dc348dc14c
- date added to LUP
- 2026-02-24 10:05:30
- date last changed
- 2026-03-09 13:04:26
@phdthesis{7c5e151b-d3b7-49d4-a543-e0dc348dc14c,
abstract = {{Background. Climate change is the greatest threat to human health in the 21st century and healthcare contributes to approximately 5% of global greenhouse gas emissions. Intensive and perioperative care are particularly resource intensive. This thesis aimed to assess the climate and environmental impacts of perioperative and intensive care (Papers I–III) and to explore how environmental outcomes and associated uncertainties can be evaluated in a clinical trial context (Paper IV).<br/><br/>Methods. Life cycle assessment (LCA) was applied in all four papers to quantify environmental impacts across the life cycle of healthcare products and activities. Papers I and II combined LCA with life cycle costing to compare single-use, reusable, and mixed systems for laparoscopic surgery and central venous catheter (CVC) insertions in a Swedish setting, and the impact on resource use, climate change, ecosystem quality and human health was assessed. Paper III applied LCA to estimate the total climate impact per inpatient day in a Swedish intensive care unit (ICU). In Paper IV, LCA was applied to compare the impact of an intervention and comparator in a clinical trial assessing fluid administration on 18 environmental outcomes, climate impact (kg CO₂eq) was the primary outcome. Group differences were analysed using a general linear model and a hierarchical mixed-effects model that incorporated LCA uncertainty.<br/><br/>Results. Reusable trocar systems and CVC insertion kits had 45–95% lower impact than the single-use alternatives on all environmental impact categories and was about half as expensive. The median climate impact of one ICU inpatient day was estimated at 30 kg CO₂eq, increasing to 126 kg CO₂eq with a high-impact energy mix. In Paper IV, results were consistent for most outcomes, with minimal differences between the statistical approaches.<br/><br/>Conclusions. In Sweden, replacing single-use items with reusable alternatives offers the greatest potential to reduce the climate impact of intensive and perioperative care, while renewable energy remains essential as a mitigating strategy globally. Simpler statistical approaches appear sufficient for evaluating environmental outcomes in clinical trials.}},
author = {{Hemberg, Linn}},
isbn = {{978-91-8021-839-9}},
issn = {{1652-8220}},
keywords = {{sustainable healthcare; life cycle assessment; intensive care; perioperative care; climate impact; environmental impacts}},
language = {{eng}},
number = {{2026:41}},
publisher = {{Lund University, Faculty of Medicine}},
school = {{Lund University}},
series = {{Lund University, Faculty of Medicine Doctoral Dissertation Series}},
title = {{Critical Care, Critical Emissions: Applying life cycle assessment on intensive and perioperative care}},
url = {{https://lup.lub.lu.se/search/files/243145105/Linn_Hemberg_-_WEBB.pdf}},
year = {{2026}},
}