Decreasing operating room costs via reduction of surgical instruments

Abstract

Background: Rising costs in health care demand waste reduction and improved efficiency throughout the hospital. Surgeons have an important role in regard to the number of instruments used in procedures. Previous studies have demonstrated instrument maintenance and sterilization cost approximately $0.51-$0.77 per instrument and found that only 13-21.9% of instruments opened are used.

Objective: The aim of the study was to reduce the surgical trays so that more than 50% of the instruments are used leading to a cost savings of at least 20% per tray. This was begun with the minor urology tray which is primarily used for orchiopexy and hernia repair.

Study design: This was a single-site, prospective study. A Plan, Do, Study, Act cycle was used. A multidisciplinary team including urologists, surgical technicians, and a central processing department representative was developed. Inguinal orchiopexy with hernia, scrotal orchiopexy, and inguinal hernia cases were randomly chosen to count the total instruments used in each procedure. The exact instruments were recorded every third case to obtain a sample of variable patients and surgeon preferences. The percentage of utilization was calculated, and a list of instruments used was created. Those not used or used less than 20% of the time were removed. The new list was reviewed with the option to add or eliminate instruments. The approved reduced list was then implemented as the genitourinary (GU) minor tray. Finally, the instruments used in 10 inguinal orchiopexy with hernia cases, 10 scrotal orchiopexy cases, and 10 inguinal hernia cases were counted. The percentage of utilization was calculated. This process was then replicated in other surgical trays.

Results: The GU minor instrument tray was reduced from 57 to 35 instruments, a 39% reduction in size. Scrotal orchiopexy uses the least instruments (16.9), a utilization percentage of 48.3% after reduction. Inguinal orchiopexy with hernia repair uses the most number of instruments (25.1) with 71.7% utilization after reduction, compared with 43% before reduction. Using the cost analysis performed by Stockert and Langerman, $11.22 was saved during each procedure; this translates to a cost savings of $3489.42 annually. After reduction, only 10% of the cases required an extra instrument to be opened. Three other surgical trays were reduced using the same method, yielding a potential savings of $14,588.

Discussion: Baseline data demonstrates low average instrument utilization rangin from 21.1% to 49.1% per case. It is estimated that each instrument costs from $0.51 to $3.19. Decreasing the number of instruments opened with each surgical procedure is a viable way to decrease costs and efficiency in the operating room.

Conclusions: Initially, the GU minor tray was successfully reduced by 39%, followed by the other surgical trays. A multidisciplinary approach is critical for success. This study showed an excellent opportunity for cost savings by decreasing reusable waste in the operating room.

Keywords: Cost; Reduction; Surgical.