Specialty (if any): Surgery, Planetary Health

Keywords: Sustainable Surgical Care, Climate Resilience and Adaptability, Philippines

Background: Planetary health, which recognizes the interdependence of human and environmental systems, calls for a transformation in healthcare delivery to protect both people and the planet. In the Philippines—one of the world’s most climate-vulnerable nations—typhoons, rising sea levels, and infrastructure instability threaten healthcare delivery, particularly surgical care, which is often excluded from climate resilience planning. Operating rooms are among the most resource- and emissions-intensive hospital areas, yet sustainability remains insufficiently incorporated in practice and policy. This study explores how Filipino surgeons perceive and engage with sustainable surgery, and how these insights can inform climate-resilient strategies aligned with planetary health.

Objective: To assess the awareness, attitudes, and practices of Filipino surgeons regarding surgical sustainability and climate resilience, and to identify barriers and opportunities for implementation in low- and middle-income settings.

Methods: A mixed-methods study was conducted using UCLA Qualtrics survey (n=45) capturing demographic data and attitudes toward sustainability in surgery using 5-point Likert-scale items. Semi-structured interviews (n=8) with surgeons across geographic regions, specialties, and practice settings explored lived experiences, institutional challenges, and perceptions of environmental responsibility. Interviews were thematically analyzed using NVivo software.

Results: Surgeons reported strong concern about environmental impact (4.60) and willingness to adopt sustainable practices (4.53), but they noted low institutional preparedness for climate-related disruptions (2.56). 95% of surgeons estimated that over 25% of surgical supplies are wasted—often due to inefficient kits, inflexible procurement, and lack of clinician input. Respondents cited gaps in sustainability training and policy alignment, particularly with accreditation standards that incentivize single-use items. Interviews revealed professional motivation constrained by systemic barriers, but also emphasized opportunities for reform through leadership engagement, education, and context-sensitive policy.

Conclusions: Filipino surgeons are poised to lead sustainable surgical transitions. Realizing this potential requires systemic change. Reusable supplies, optimized workflows, and integrated sustainability curricula can help build climate-resilient surgical systems in the Philippines and beyond.