Implementing a perioperative efficiency initiative for orthopedic surgery instrumentation at an academic center

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.

The use of preoperative planning to decrease costs and increase efficiency in the OR

“…Our intervention group (group 1) had a plan that the surgeon used specifically to guide implant selection while operating; it was followed and utilized during surgery, whereas the control group had a plan that was reviewed; however, the surgeon did not use it to guide and restrict the trays or implants that were brought into the OR. All patients underwent a preoperative plan as a standard of care for this surgeon and patients in group 1 were collected from 2018 to 2020; given the published accuracy of 3D templating software 1 , 2 , 3 , 4 , 11 , 12 , 13 to guide addressing pathology and implant selection, the surgeons changed their practice to base the intraoperative plan and implant selection off of the preoperative planning software selections. This practice evolution was applied for all shoulder arthroplasty patients to minimize any bias in patient selection.…”

The Modern Universal Total Knee Arthroplasty: Maximized Value, Streamlined Efficiency

“…If a surgeon is able to reduce the number of instrument trays the savings could be huge, with one study looking at a reduction from 7.5 trays in a TKA to three trays. This reduction led to an estimated annual savings of $159,600 in sterilization costs and $99,000 in improved turnover times [30]. Each tray costs between $60 and $150 dollars to sterilize, and each tray averages 2 minutes to open onto the With a modern universal total knee system, a single standard instrument tray may be used for up to 90% of primary total knee arthroplasty while following AORN guidelines to weigh less than 25 lbs.…”

3D Printed Patient-Specific Complex Hip Arthroplasty Models Streamline the Preoperative Surgical Workflow: A Pilot Study

“…For complex cases, multiple sizes of acetabular cup, augments and cages are required in preparation for a definitive plan based on intraoperative findings. This equipment can comprise up to 14 trays for a standard THA with further equipment required for complex cases (24), conferring a significant logistical burden on the healthcare system. In addition, reducing the number of trays required in preparation would reduce the financial and environmental impact of the hospital.…”