Global Public Health Impact of Recovered Supplies from Operating Rooms: A Critical Analysis with National Implications

Wan, Eric L.; Xie, Li; Barrett, Miceile D.; Baltodano, Pablo A.; Rivadeneira, Andres F.; Noboa, Jonathan; Silver, Maya; Zhou, Richard; Cho, Suzy; Tam, Tammie; Yurter, Alp; Gentry, Carol; Palacios, Jorge Humberto Rojas; Rosson, Gedge D.; Redett, Richard J.

doi:10.1007/s00268-014-2834-2

Cited by 22 publications

(14 citation statements)

References 24 publications

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“…In summary, our work shows that that there is a large variation and significant magnitude of preventable OR waste (an estimated average of $968 per neurosurgical case), much higher than that suggested by prior studies of recoverable materials for international donations 5,8 or documentation of waste in tonsillectomy procedures. 4 Our calculations may actually represent underestimates of true OR waste, both due to selection bias (namely, overrepresentation of low-waste vascular cases, which we have corrected for in our extrapolations), as well as the fact that nurses commented they were less likely to open disposable supplies when they knew they were under observation.…”

Section: Discussioncontrasting

confidence: 52%

“…for overseas donations, suggesting a significant amount of OR waste. 5,8 Only 1 study, however, tried to identify disposable medical supplies that were unnecessarily opened for each case, discovering approximately $11 of unused disposable supplies per tonsillectomy case. 4 Based on these findings and our own observations in the OR, we predicted that there were even greater amounts of preventable OR waste in neurosurgery.…”

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confidence: 99%

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Operating room waste: disposable supply utilization in neurosurgical procedures

Zygourakis

Yoon

Valencia

et al. 2017

JNS

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OBJECTIVE Disposable supplies constitute a large portion of operating room (OR) costs and are often left over at the end of a surgical case. Despite financial and environmental implications of such waste, there has been little evaluation of OR supply utilization. The goal of this study was to quantify the utilization of disposable supplies and the costs associated with opened but unused items (i.e., "waste") in neurosurgical procedures. METHODS Every disposable supply that was unused at the end of surgery was quantified through direct observation of 58 neurosurgical cases at the University of California, San Francisco, in August 2015. Item costs (in US dollars) were determined from the authors' supply catalog, and statistical analyses were performed. RESULTS Across 58 procedures (36 cranial, 22 spinal), the average cost of unused supplies was $653 (range $89-$3640, median $448, interquartile range $230-$810), or 13.1% of total surgical supply cost. Univariate analyses revealed that case type (cranial versus spinal), case category (vascular, tumor, functional, instrumented, and noninstrumented spine), and surgeon were important predictors of the percentage of unused surgical supply cost. Case length and years of surgical training did not affect the percentage of unused supply cost. Accounting for the different case distribution in the 58 selected cases, the authors estimate approximately $968 of OR waste per case, $242,968 per month, and $2.9 million per year, for their neurosurgical department. CONCLUSIONS This study shows a large variation and significant magnitude of OR waste in neurosurgical procedures. At the authors' institution, they recommend price transparency, education about OR waste to surgeons and nurses, preference card reviews, and clarification of supplies that should be opened versus available as needed to reduce waste.

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Section: Discussioncontrasting

confidence: 52%

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confidence: 99%

Operating room waste: disposable supply utilization in neurosurgical procedures

Zygourakis

Yoon

Valencia

et al. 2017

JNS

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“…However, many charitable organisations have been set up to alleviate short-term needs by providing discarded clean and unused medical supplies from HIC hospitals 95–98. If run appropriately, such cost-effective needs-based donation could reduce waste and provide substantial benefits to recipient communities 99. However, while up to 70% of medical equipment in sub-Saharan Africa is donated,100 current estimates suggest that only 10%–30% of this becomes operational 101 102.…”

Section: Volunteering and Charitable Supportmentioning

confidence: 99%

What is ‘global surgery’? Defining the multidisciplinary interface between surgery, anaesthesia and public health

Bath

Bashford

Fitzgerald³

2019

BMJ Glob Health

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‘Global surgery’ is the term adopted to describe a rapidly developing multidisciplinary field aiming to provide improved and equitable surgical care across international health systems. Sitting at the interface between numerous clinical and non-clinical specialisms, it encompasses multiple aspects that surround the treatment of surgical disease and its equitable provision across health systems globally. From defining the role of, and need for, optimal surgical care through to identifying barriers and implementing improvement, global surgery has an expansive remit. Advocacy, education, research and clinical components can all involve surgeons, anaesthetists, nurses and allied healthcare professionals working together with non-clinicians, including policy makers, epidemiologists and economists. Long neglected as a topic within the global and public health arenas, an increasing awareness of the extreme disparities internationally has driven greater engagement. Not necessarily restricted to specific diseases, populations or geographical regions, these disparities have led to a particular focus on surgical care in low-income and middle-income countries with the greatest burden and needs. This review considers the major factors defining the interface between surgery, anaesthesia and public health in these settings.

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“…However, it is well-known that these supplies are needed elsewhere. The Recovered Medical Equipment for the Developing World (REMEDY) project, implemented at Yale University School of Medicine in 1991, was one of the first attempts to organize a systematic collection and inventory protocol for unused medical supplies in the US intended for donation abroad [1][2][3][4]. In 2013, one group conducted a pilot study with two tertiary care centers in Guayaquil, Ecuador to assess the utility of donated supplies and assessed the disabilityadjusted life years (DALY) averted as a result of donated supplies [5].…”

Section: Introductionmentioning

confidence: 99%

A Post-donation Survey to Assess the Appropriateness of Medical Supply Donations to Freetown, Sierra Leone Following the Ebola Crisis

Trye

Maloney

Jalal

et al. 2020

Cureus

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The Recovery of Equipment for Capacity building OVERseas (RECOVER) initiative at Rutgers New Jersey Medical School involves collection and donation of clean and unused medical supplies that would otherwise be discarded to those desperately in need of those supplies abroad. RECOVER has recently responded to the aftermath of the Ebola crisis and the even more recent mudslide natural disaster in Freetown, Sierra Leone, which had resulted in a considerable diminishing of the local medical supplies. The goal of this study was to assess the match between donated supplies and local needs by using a post-donation survey. In December 2016, we conducted a pre-donation survey inquiring which of the supplies available from RECOVER were needed by four hospitals in Freetown. The survey also asked about specific barriers to keeping such supplies in stock. After each hospital received a shipment of supplies, we administered an online Qualtrics (Qualtrics, Provo, UT) follow-up survey intending to assess the appropriateness of the donated supplies. The survey asked about which wards used what supplies, most useful items, ability to sterilize, and whether the donation provided supplies that would otherwise need to be bought. Recipient hospitals reported the use of 90% of donated supplies. The most useful supplies were gowns, scalpels, gloves, and drapes; All recipients reported the ability to sterilize donated goods. Supplies were used in operating rooms, emergency rooms, and medical wards. Donated supplies provided hospitals with supplies that would typically need to be bought or that were unavailable in the region. No adverse events were reported related to the use of donated supplies. At first glance, our donations appear usable and appropriate for the recipients. We hope to provide a framework for an objective measure of need for hospitals in other low-income countries, using the Freetown post-Ebola crisis as a pilot for the assessment of medical supply donations and the longitudinal impact it can have on global health and surgery overseas. More studies are required to further explore the possible implications of our program including those relating to medical waste management and environmental considerations when donating and shipping disposable supplies to a developing country.

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Global Public Health Impact of Recovered Supplies from Operating Rooms: A Critical Analysis with National Implications

Abstract: Hospital operating rooms continue to represent a large source of recoverable surgical supplies that have demonstrable health benefits in the recipient communities. Cost-effective recovery and need-based donation programs can significantly alleviate the global burden of surgical diseases.

Cited by 22 publications

References 24 publications

Operating room waste: disposable supply utilization in neurosurgical procedures

Operating room waste: disposable supply utilization in neurosurgical procedures

What is ‘global surgery’? Defining the multidisciplinary interface between surgery, anaesthesia and public health

A Post-donation Survey to Assess the Appropriateness of Medical Supply Donations to Freetown, Sierra Leone Following the Ebola Crisis

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