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. 2019 Feb;98(7):e14338.
doi: 10.1097/MD.0000000000014338.

Implementing a perioperative efficiency initiative for orthopedic surgery instrumentation at an academic center: A comparative before-and-after study

Richard Capra  1 , Stefano A Bini  1 , Dawn E Bowden  2 , Katherine Etter  2 , Matt Callahan  1 , Richard T Smith  2 , Thomas Parker Vail  1
Affiliations

Implementing a perioperative efficiency initiative for orthopedic surgery instrumentation at an academic center: A comparative before-and-after study

Richard Capra et al. Medicine (Baltimore). 2019 Feb.

Abstract

Optimizing surgical instrumentation may contribute to value-based care, particularly in commonly performed procedures. We report our experience in implementing a perioperative efficiency program in 2 types of orthopedic surgery (primary total-knee arthroplasty, TKA, and total-hip arthroplasty, THA).A comparative before-and-after study with 2 participating surgeons, each performing both THA and TKA, was conducted. Our objective was to evaluate the effect of surgical tray optimization on operating and processing time, cost, and waste associated with preparation, delivery, and staging of sterile surgical instruments. The study was designed as a prospective quality improvement initiative with pre- and postimplementation operational measures and a provider satisfaction survey.A total of 96 procedures (38 preimplementation and 58 postimplementation) were assessed using time-stamped performance endpoints. The number and weight of trays and instruments processed were reduced substantially after the optimization intervention, particularly for TKA. Setup time was reduced by 23% (6 minutes, P = .01) for TKA procedures but did not differ for THA. The number of survey respondents was small, but satisfaction was high overall among personnel involved in implementation.Optimizing instrumentation trays for orthopedic procedures yielded reduction in processing time and cost. Future research should evaluate patient outcomes and incremental/additive impact on institutional quality measures.

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Conflict of interest statement

DEB, KE, and RTS are employees of Johnson & Johnson Medical Devices Companies; SAB and TPV have been consultants to DePuy Orthopaedics; RC and MC declare no conflicts of interest.

Figures

Figure 1
Figure 1
Optimized tray configuration. TKA = total-knee arthroplasty, THA = total-hip arthroplasty.
Figure 2
Figure 2
Percent change in study endpoints, ∗P = .06 for pre- vs postimplementation of optimized surgical trays, †Reduction of at least 10% from pre- to postimplementation of optimized surgical trays. These endpoints are comparisons of the new instrument and tray configuration to the previous configuration (counts, not means with variation); no statistical test of significance is available.
See this image and copyright information in PMC

References

    1. Burd C, Brown NC, Puri P, et al. A Centers for Medicare & Medicaid Services lens toward value-based preventive care and population health. Public Health Rep 2017;132:6–10. - PMC - PubMed
    1. HCUP Fast Stats. Healthcare Cost and Utilization Project (HCUP). November 2017. Agency for Healthcare Research and Quality, Rockville, MD. Available at: www.hcup-us.ahrq.gov/faststats/national/inpatientcommonprocedures Accessed March 23, 2018.
    1. Kurtz SM, Ong KL, Lau E, et al. Impact of the economic downturn on total joint replacement demand in the United States: updated projections to 2021. J Bone Joint Surg Am 2014;96:624–30. - PubMed
    1. Fong AJ, Smith M, Langerman A. Efficiency improvement in the operating room. J Surg Res 2016;204:371–83. - PubMed
    1. Stockert EW, Langerman A. Assessing the magnitude and costs of intraoperative inefficiencies attributable to surgical instrument trays. J Am Coll Surg 2014;219:646–55. - PubMed

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