Environmental impact of travel to neurosurgery outpatient appointments in South Australia

Outpatient attendance at metropolitan neurosurgical clinics imposes significant logistical and psychosocial burdens on patients, particularly those with central nervous system tumours residing in geographically dispersed regions. In Australia, where vast distances separate many regional populations from tertiary care centres, these burdens may also translate into substantial environmental costs. This study sought to quantify the environmental and economic impact associated with patient travel to public neurosurgery outpatient services in South Australia.

A retrospective analysis was conducted using administrative data from all in-person public neurosurgery outpatient appointments across South Australia’s two public neurosurgical centres between July 2022 and June 2024. Patient postcode data were used to calculate geodesic one-way travel distances to clinic sites. Estimated fuel consumption, carbon dioxide (CO₂) emissions, and petrol costs were derived using published national averages for vehicle efficiency and emissions. Analyses were stratified by Modified Monash Model (MMM) classification to assess regional variation.

The cohort comprised 9840 patients, accounting for 19,148 outpatient appointments. The median one-way travel distance was 17.7 km (IQR: 9.4–52.1 km), with 16.9% of patients travelling over 100 km. The cumulative distance travelled was 1.75 million km over 2 years, equating to an estimated petrol consumption of 185,531 L and CO₂ emissions of 435.6 tonnes. The associated direct fuel cost exceeded AUD 357,000. Although individual environmental impact increased with MMM classification, the highest aggregate emissions were attributable to patients in MMM category 5, reflecting both travel distance and patient volume.

The environmental and financial burdens associated with outpatient neurosurgical care are considerable, particularly for patients in rural and remote areas. These findings underscore the need to explore sustainable models of care, including the expanded use of telehealth and regional outreach services, as strategies to reduce carbon emissions and improve healthcare accessibility.