Optimizing spine surgery instrument trays to immediately increase efficiency and reduce costs in the operating room

Abstract

Background: Over-crowded surgical trays result in perioperative inefficiency and unnecessary costs. While methodologies to reduce the size of surgical trays have been described in the literature, they each have their own drawbacks. In this study, we compared three methods: (1) clinician review (CR), (2) mathematical programming (MP), and (3) a novel hybrid model (HM) based on surveys and cost analysis. While CR and MP are well documented, CR can yield suboptimal reductions and MP can be laborious and technically challenging. We hypothesized our easy-to-implement HM would result in a reduction of surgical instruments in both the laminectomy tray (LT) and basic neurosurgery tray (BNT) that is comparable to CR and MP.

Methods: Three approaches were tested: CR, MP, and HM. We interviewed 5 neurosurgeons and 3 orthopedic surgeons, at our institution, who performed a total of 5437 spine cases, requiring the use of the LT and BNT over a 4-year (2017-2021) period. In CR, surgeons suggested which surgical instruments should be removed. MP was performed via the mathematical analysis of 25 observations of the use of a LT and BNT tray. The HM was performed via a structured survey of the surgeons' estimated instrument usage, followed by a cost-based inflection point analysis.

Results: The CR, MP, and HM approaches resulted in a total instrument reduction of 41%, 35%, and 38%, respectively, corresponding to total cost savings per annum of $50,211.20, $46,348.80, and $44,417.60, respectively.

Conclusions: While hospitals continue to examine perioperative services for potential inefficiencies, surgical inventory will be increasingly scrutinized. Despite MP being the most accurate methodology to do so, our results suggest that savings were similar across all three methods. CR and HM are significantly less laborious and thus are practical alternatives.

Keywords: Clinician review; Cost savings; Mathematical model; Newsvendor model; Optimization; Spine surgery; Standardization; Surgical instruments; Surgical trays.

Fig. 1

Number of instruments on the laminectomy tray and basic neurosurgery tray pre- and postoptimization.

Fig. 2

Annual reprocessing time (days) of laminectomy trays and basic neurosurgery trays pre- and postoptimization.

Fig. 3

Annual cost savings (in Canadian dollars) of maintaining the laminectomy trays and basic neurosurgery trays postoptimization. The annual cost of maintaining laminectomy trays and basic neurosurgery trays comprises the cost of reprocessing the instruments, the cost of the time spent reprocessing the instruments, and the depreciation cost of each instrument.