Process optimization in total knee arthoplasty procedures

Eiff, Maximilian C. von; Eiff, Wilfried von; Röth, Andreas; Ghanem, Mohamed

doi:10.1007/s00132-019-03803-9

Cited by 9 publications

(24 citation statements)

References 22 publications

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“…Any amount of time saved in the OR is of high value, with published costs ranging from US $20 to US $62 per minute 5,13 . Greater efficiency during and in between cases achieved by reducing setup time also creates the opportunity to better estimate staffing requirements, reduce overtime-related personnel expenses, and potentially schedule additional procedures to improve contribution margin 6,9,17,29 …”

Section: Discussionmentioning

confidence: 99%

“…5,13 Greater efficiency during and in between cases achieved by reducing setup time also creates the opportunity to better estimate staffing requirements, reduce overtime-related personnel expenses, and potentially schedule additional procedures to improve contribution margin. 6,9,17,29 The removal of excess instrumentation from trays has been consistently proven to significantly reduce set assembly times, thereby reducing costs associated with that step in the sterile processing department. 11,17,22,27 Prior studies have also reported the ergonomic benefits of instrument tray reduction associated with a significant decrease in tray weight.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, instrument tray optimization has been successful in reducing avoidable expense at numerous institutions 4,5,9–31 . Those prior studies have included all major surgical specialties, both adult and pediatric, and the full spectrum of procedure types, ranging from simple to complex.…”

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confidence: 99%

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Data Analysis of Plastic Surgery Instrument Trays Yields Significant Cost Savings and Efficiency Gains

et al. 2021

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Purpose Inpatient surgery costs have risen 30% over the past 5 years, and the operating room accounts for up to 60% of total hospital operational expense. On average, only 13.0% to 21.9% of instruments opened for a case are used, contributing to significant avoidable reprocessing, repurchase, and labor expense. Methods A comprehensive review of 40 major instrument trays at UNC Rex Hospital was conducted using a technology service (OpFlow; Operative Flow Technologies, Raleigh, NC). Among the full scope of the project, the general plastics tray and breast reconstruction tray were evaluated for the plastic surgery service line over a 3-month period. Intraoperative data collection was performed on the exact instruments used across a standard breadth of cases. Data analytics were conducted stratifying instrument usage concordance among surgeons by tray and procedure type. After a surgeon-led review of the proposed new tray configurations, the optimized versions were implemented via a methodical change management process. Results A total of 183 plastic surgery cases were evaluated across 17 primary surgeons. On average, the instrument usage per tray was 15.8% for the general plastics tray and 23.5% for the breast reconstruction tray. After stakeholder review, 32 (45.1%) of 71 instruments were removed from the general plastics tray and 40 (36.7%) of 109 were removed from the breast reconstruction tray, resulting in a total reduction of 2652 instruments. This resulted in a decrease of 81,696 instrument sterilization cycles annually. The removal of the instruments yielded an estimated cost avoidance of US $163,800 for instrument repurchase and US $69,441 in annual resterilization savings. The instrument volume reduction is projected to save 383.5 hours of sterile processing personnel time in tray assembly annually. Conclusions An analytics-driven method applying empirical data on actual case-based instrument usage has implications for better efficiency, improved quality, and cost avoidance related to instrument repurchase and sterile processing. Given increasing cost constraints and the transition to value-based care models, leveraging a technology-based solution enables meaningful change in the sterile processing department as a source for cost reduction and quality of care improvement.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Data Analysis of Plastic Surgery Instrument Trays Yields Significant Cost Savings and Efficiency Gains

et al. 2021

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“…Cost data were obtained from German Diagnosis-Related Groups 34 , published literature 35-37 , and expert opinion (Table I). For the augmentation group, the material costs of augmentation and leakage-test costs were obtained from the German DePuy Synthes price list, and costs related to additional operating room (OR) time (an estimated 5-minute increase in average surgical time based on the RCT 25 ) were calculated with use of an OR rate of €15/minute 38 . Costs related to the index procedure or other complications were not considered because these were assumed to be identical for both treatment groups.…”

Section: Methodsmentioning

confidence: 99%

“…The costs of revision surgery, outpatient visits, and rehabilitation following revision were included in the model. Cost data were obtained from German Diagnosis-Related Groups 34 , published literature [35][36][37] , and expert opinion (Table I). For the augmentation group, the material costs of augmentation and leakage-test costs were obtained from the German DePuy Synthes price list, and costs related to additional operating room (OR) time (an estimated 5-minute increase in average surgical time based on the RCT 25 ) were calculated with use of an OR rate of €15/minute 38 .…”

Section: Costsmentioning

confidence: 99%

Cost-Effectiveness of Cement Augmentation Versus No Augmentation for the Fixation of Unstable Trochanteric Fractures

Joeris

Kabiri

Galvain

et al. 2022

Journal of Bone and Joint Surgery

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Background:A previous randomized controlled trial (RCT) demonstrated a trend toward a reduced risk of implant-related revision surgery following fixation with use of a Proximal Femoral Nail Antirotation (PFNA) with TRAUMACEM V+ Injectable Bone Cement augmentation versus no augmentation in patients with unstable trochanteric fractures. To determine whether this reduced risk may result in long-term cost savings, the present study assessed the cost-effectiveness of TRAUMACEM V+ cement augmentation versus no augmentation for the fixation of unstable trochanteric fractures from the German health-care payer’s perspective.Methods:The cost-effectiveness model comprised 2 stages: a decision tree simulating clinical events, costs, and utilities during the first year after the index procedure and a Markov model extrapolating clinical events, costs, and utilities over the patient’s lifetime. Sources of model parameters included the previous RCT, current literature, and administrative claims data. Outcome measures were incremental costs (in 2020 Euros), incremental quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). Model uncertainty was assessed with deterministic and probabilistic sensitivity analyses.Results:The base-case analysis showed that fixation with cement augmentation was the dominant strategy as it was associated with cost savings (€50.3/patient) and QALY gains (0.01 QALY/patient). Major influential parameters for the ICER were the utility of revision, rates of revision surgery within the first year after fixation surgery, and the costs of augmentation and revision surgery. Probabilistic sensitivity analyses demonstrated that estimates of cost savings were more robust than those of increased QALYs (66.4% versus 52.7% of the simulations). For a range of willingness-to-pay thresholds from €0 to €50,000, the probability of fixation with cement augmentation being cost-effective versus no augmentation remained above 50%.Conclusions:Fixation with use of cement augmentation dominated fixation with no augmentation for unstable trochanteric fractures, resulting in cost savings and QALY gains. Given the input parameter uncertainties, future analyses are warranted when long-term costs and effectiveness data for cement augmentation are available.Level of Evidence:Economic and Decision Analysis Level II. See Instructions for Authors for a complete description of levels of evidence.

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Discussion and Future Possibilities

Walker

2020

The Artificial Knee

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Process optimization in total knee arthoplasty procedures

Cited by 9 publications

References 22 publications

Data Analysis of Plastic Surgery Instrument Trays Yields Significant Cost Savings and Efficiency Gains

Data Analysis of Plastic Surgery Instrument Trays Yields Significant Cost Savings and Efficiency Gains

Cost-Effectiveness of Cement Augmentation Versus No Augmentation for the Fixation of Unstable Trochanteric Fractures

Discussion and Future Possibilities

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