Association of Operating Room Costs With Head and Neck Surgical Instrumentation Optimization

Abstract

In an era of increasing health care expenditure, reduction of redundant head and neck surgical instrumentation may minimize waste.OBJECTIVE To (1) optimize head and neck surgical instrument trays at a single large academic tertiary care center and (2) identify associated direct cost savings. DESIGN, SETTING, AND PARTICIPANTSThis prospective quality improvement initiative was conducted at an academic tertiary care medical center from July 2017 through July 2021. Participants were a multidisciplinary surgical quality team consisting of head and neck surgeons, operating room nurses, surgical technicians, and supply chain analysts. MAIN OUTCOMES AND MEASURESThe 4 primary surgical instrument trays (major otolaryngology [Oto], Oto plastics, direct laryngoscopy, and microdirect laryngoscopy) used in all head and neck procedures were reviewed by 10 head and neck surgical faculty with detailed case observation of instrument utilization performed by trained operating room nurses and surgical technologists. Instruments used in less than 40% of cases were excluded from surgical trays, and novel instrument trays were established based on faculty feedback and utilization. Data on instrument processing, utilization, and associated institutional direct costs were prospectively collected over a 3-year period. The primary outcome measure was change in operating room direct costs. Surgeon satisfaction with the quality improvement intervention was the secondary outcome. Direct cost savings were identified as a function of surgical volume, labor and supply costs, and instrument depreciation.RESULTS More than 1500 eligible surgical cases were reviewed during the preintervention period. Of the 149 instruments in the major Oto tray, only 118 (79%) instruments were used in more than 40% of cases. There were 58 (49%) and 32 (21%) instruments in this tray that were used in more than 40% of neck dissections and sentinel lymph node biopsies, respectively. Resulting intervention included development of a streamlined major Oto tray with 118 instruments and novel neck dissection and sentinel lymph node biopsy trays. Similar processes were applied to the remaining head and neck trays, with a total of 257 instruments removed. Over a 3-year postintervention period, streamlined surgical trays were used 9284 times with direct cost savings of $228 338 (95% CI, $227 817-$228 854). Overall surgeon satisfaction with the optimized head and neck surgical trays was 100%. CONCLUSIONS AND RELEVANCEIn this quality improvement study, surgeon-led elimination of redundant or rarely used instruments from surgical instrument trays was associated with reduced operating room direct costs while maintaining stakeholder satisfaction.

Attitudes and Perceptions of Canadian Otolaryngology‐Head and Neck Surgeons and Residents on Environmental Sustainability

“…Reviewing surgical tray contents can reduce unnecessary reprocessing/waste, costs, and set‐up time, while maintaining surgeon satisfaction. 31 , 40 , 41 , 42 , 43 , 44 Reusable gowns are shown to produce less GHGs than disposable gowns per 1000 uses. 45 As noted in our thematic analyses, collaboration with anesthesia to consider total intravenous anesthesia (TIVA) or regional/neuraxial blocks can mitigate the environmental impact of anesthetic gases.…”

“…These are examples of eco‐action which can be taken by the practicing otolaryngologists. Reviewing surgical tray contents can reduce unnecessary reprocessing/waste, costs, and set‐up time, while maintaining surgeon satisfaction 31,40‐44 . Reusable gowns are shown to produce less GHGs than disposable gowns per 1000 uses 45 .…”

Environmental sustainability in otolaryngologic surgery

“…A recent study on tray reformulation with removal of instruments used in less than 40% of sentinel lymph node biopsy and neck dissection cases demonstrated a direct cost savings of $288 338 in the 3 years and 9284 cases following tray reformulation. Surgeon satisfaction with the streamlined trays was 100% [28 ▪ ]. Studies on SUD in OHNS are limited; however, life-cycle analyses in other fields have shown environmental and cost benefits associated with the use of reusable devices instead of SUD.…”

Reducing Surgical Instruments In Otolaryngology Instrument Trays—Realized Cost Savings Remain Uncertain—Reply

“…The primary outcome measure was change in operating room direct costs associated with streamlined surgical tray implementation. Unlike cost-effectiveness studies, which offer the predicted value of an intervention, the cost savings described from 2017 to 2022 were realized, direct instrument processing savings experienced by the institution’s Sterile Processing Department (SPD) …”