Appropriate care and sustainable anaesthesiology

With stagnating life expectancy in developed nations, rising incidence of chronic diseases and mounting costs of care, the call for transforming healthcare into an efficient and sustainable sector has never been more pressing. In this thesis, meta-research on appropriate care and sustainability was combined with qualitative research and guideline development. The overall aim of the thesis was to enable changes in clinical and scientific behaviour that promote appropriate and sustainable healthcare.
The findings of this thesis indicate that methodological limitations, unrealistic expectations and the use of inappropriate outcomes measures may limit the translation of study results into clinical practice. Moreover, our results suggest that all those involved in research – researchers, funders, editors – are inclined to favour innovation above evaluation. These findings were translated into clinical practice by interviewing anaesthetists about clinical decision-making. Reported barriers to change included a prevailing lack of evidence for everyday interventions, patient and societal pressures and expectations, and financial incentives to ‘do more’.
This thesis further focussed on the largest source of environmental pollution originating from anaesthesiology, which is the use of anaesthetic gases. These gases are potent greenhouse gases, ‘forever chemicals’ (PFAS) and cause ozone layer depletion. We performed two systematic reviews with meta-analyses and concluded that omitting anaesthetic gases from general anaesthesia is safe and effective, and actually improved postoperative recovery. To promote sustainable change among anaesthetists, we additionally collected qualitative data through questionnaires and interviews and combined these to create a national guideline in close collaboration with the Dutch Society for Anaesthesiology.