Surgical Instrument Optimization: Summary of Key Studies
Cichos, KH; Hyde, CB. Optimization of Orthopedic Surgical Instrument Trays: Lean Principles to Reduce Fixed Operating Room Expenses. Journal of Arthroplasty (2019): 34:2834e-2840e
Twenty-three independent orthopedic surgical instrument trays at an academic hospital were reviewed from 2017 to 2018. Using Lean methodology, surgeons agreed upon the fewest number of instruments needed for each of the procedure trays. Instrument usage counts, cleaning times, room turnover times, tray weight, holes in tray wrapping, wet trays, and time invested to optimize each tray were tracked. The calculated total annual savings was $270,976 (20% overall cost reduction).
Dekonenko, C; Oyetunji, TA; Rentea, RM. Surgical tray reduction for cost saving in pediatric surgical cases: A qualitative systematic review. Journal of Pediatric Surgery (2020) 55(11):2435-2441.
This review of pediatric surgical tray standardization and cost-effectiveness found that on average, discontinuation of disposable instruments and standardization of equipment resulted in a removal of 40%-70% of surgical instruments per set. This yielded a cost savings of 20% (an average of $200), with no intraoperative complications or perceived safety issues.
Farrelly, JS; Clemons, C. Surgical tray optimization as a simple means to decrease perioperative costs. The Journal of Surgical Research. (2017) 220:320-326
Yale New Haven Medical evaluated instrument use across five surgical sections with the goal of cost reduction. The pediatric surgery section eliminated an average of 59.5% of instruments per tray, resulting in 45,856 fewer instruments processed per year, and nine trays eliminated from rotation. Processing time for six commonly used trays was reduced by 29%. Among all five surgical sections, annual instrument cost avoidance after tray optimization was estimated at $53,193 to $531,929.
Farrokhi, FR; Gunther, M; et al. (2015) Application of lean methodology for improved quality and efficiency in operating room instrument availability. J Healthc Qual. 37(5):277-86
Lean methodology was applied to determine instrument usage and waste, remove unnecessary instruments, and standardize trays for a given procedure. The primary outcome was a reduction in unnecessary instruments delivered to the operating room. As a secondary step, Lean analysis helped reduce the number of instruments for minimally invasive spine surgery by 70% (from 197 to 58), and setup time by 37%.
John-Baptiste, A; Sowerby, LC; et al. Comparing surgical trays with redundant instruments with trays with reduced instruments: a cost analysis. CMAJ Open. (2016): 4(3):E404-E408
This Canadian study compared the direct costs of trays containing redundant instruments to reduced trays for five otolaryngology procedures and found the cost of redundant trays was $21,806 and the cost of reduced trays was $8,803, for a 1-year cost saving of $13,000.
Kim, SH; Kim, HY. Reducing Supply Cost by Standardization of Surgical Equipment in Laparoscopic Appendectomy. Quality Management in Health Care. (2021) 30(4):259-266
A South Korean study found that the use of a standard laparoscopic appendectomy equipment set established by consensus opinions of nine board-certified surgeons decreased intraoperative costs for laparoscopic appendectomies by 25%.
Knowles, M; Gay, SS; et al. (2021) Data analysis of vascular surgery instrument trays yielded large cost and efficiency savings. J Vasc Surg. 73(6); 2144-2153
An observational study at one hospital found that less than 20% of surgical instruments were used in vascular and aortic procedures. After clinician review, 780 instruments were removed from the 13 types of vascular trays and 475 from five instances of aortic trays.
Lonner, JH; Goh, GS; et al. Minimizing Surgical Instrument Burden Increases Operating Room Efficiency and Reduces Perioperative Costs in Total Joint Arthroplasty. The Journal of Arthroplasty (2021) 36(6):1857-1863
Only 45.5% of instruments in total joint arthroplasty were used. After Lean-based optimization, 28 of 87 (32.2%) instruments were removed and the remainder could be stored in one tray. Mean set-up time decreased from 20.7 to 14.2 minutes, while 40-75 minutes were saved during the sterilization process. Average annual savings amounted to $281,298 for just four procedures.
Shaw, A; Chan, YY; et al. (2022) Streamlining surgical trays for common pediatric urology procedures: A quality improvement initiative. J Pediatr Urol;18(4):412.e1-412.e7
A team of QI, OR and sterile processing staff looked at instruments used in one of the most common procedures. Tools decreased from 146 to 65 per tray, set-up time decreased from 7.3 to 3.5 minutes, and tray weight dropped by 6 pounds.
Stockert, EM; and Langerman, A. Assessing the Magnitude and Costs of Intraoperative Inefficiencies Attributable to Surgical Instrument Trays. Journal of the American College of Surgery. (2014): 219(4):646-55
Researchers at the University of Chicago Medical Center discovered that 49 procedures in just four surgical specialties accounted for 237 different 5 tray configurations. Eighty-seven percent of instruments in otolaryngology, 85% in plastic surgery, 82% in bariatric surgery and 82% in neurosurgery were never used. An increasing number of instruments per tray was associated with decreased use and increased instrument error rate. The total cost of cleaning and repackaging an individual instrument for each case was 51 cents.
Toor, J; Bhangu, A. (2022) Optimizing the surgical instrument tray to immediately increase efficiency and lower costs in the operating room. Can J Surg 65(2)
Utilization of instruments on the major orthopedic tray at a large academic hospital was documented over 80 procedures. Results of the observations were applied to a customized mathematical model to determine the ideal tray configuration. The model produced an ideal tray size of 47 instruments, a reduction of 41 instruments from the original size of 88 instruments (47% reduction).
Van Meter, MM; Adam, RA. Costs associated with instrument sterilization in gynecologic surgery. American Journal of Obstetrics and Gynecology. (2016) 215(5):652.e1-652.e5
This single-site observational study of 28 gynecologic surgical cases (5 abdominal, 11 laparoscopic and 12 vaginal) found that surgeons used an average of 36.7 of 184 available instruments per case, for a usage rate of around 20.5%. Instrument use was correlated inversely with the number of instruments, with an average usage rate of 18.7% for trays that contained 10 instruments. Total annual per-instrument processing cost $3.19.
Weprin, SA; Meyer, D; et al. Incidence and OR team awareness of “near miss” and retained surgical sharps: a national survey on United States operating rooms. Patient Safety in Surgery (2021) 15(1):14
Researchers at Denver Health and the University of Colorado surveyed anesthesiologists, surgeons, and nurse/technologists on incidence of retained surgical instruments as well as near misses, in which instruments were not found. An average incidence of 4.4 lost instruments per 1,000 surgeries was found, with an average of 21 to 30 minutes spent searching. Adding in the use of X-rays, a lost instrument event results in up to 70 minutes of added OR time. Although previous research found that one retained surgical item occurred in every 5,500 surgeries, this study suggests incidence of one event per 3,800 surgeries.