Reducing instruments in a vitrectomy surgical tray: cost savings and results from a major academic hospital

Abstract

Background: Unused or rarely used instruments in standard surgical trays can unnecessarily increase costs. Prior studies have demonstrated the practicality and cost savings of reduced instrument tray sizes in various subspecialties. This study describes results and estimated cost savings from a reduced instrument tray used for vitrectomy surgery at a large, tertiary academic medical center. Methods: Common usage patterns of vitrectomy instruments by one retina surgeon were reviewed and a reduced instrument vitrectomy tray was created and implemented in successive vitrectomy surgeries. Need for opening the previously utilized larger tray was recorded. Estimated cost savings of the new trays were calculated based upon per instrument sterilization, processing, and instrument replacement costs. Results: New vitrectomy trays including just 7 instruments (89% reduction compared to original trays) were created and implemented in 189 successive cases. The original tray was never opened. Estimated cost savings from saved sterilization and processing resources is approximately $9588 per year. Assuming 5-and 10-year lifespan per instrument, annual cost avoidance is projected at $7886 and $15,772, respectively. Other indirect benefits relevant to healthcare quality were also noted. Conclusion: A reduced instrument tray can be successfully implemented for vitrectomy surgery and can result in significant indirect benefits as well as direct cost savings from reduced sterilization costs. Our study highlights the substantial impact made by evaluating the usage pattern and making appropriate instrument tray changes for just one retina surgeon. Applying these same methods to other surgeons and specialties can have significant implications on healthcare costs and quality.

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

“…Operating room setup times have routinely decreased at a statistically significant level in prior publications after the reduction of non–value-added instruments 4,12,14,17,18,22,24,26–28 . 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 .…”

“…In support of surgeon acceptance to these process improvement initiatives, high satisfaction has consistently been reported among the surgical team 4,5,22,27,28 . Surgeons have the unique purview and ability to identify opportunities to improve resource utilization in the OR, and with the ever-increasing focus on improving value in health care, surgeons have an opportunity to take the lead in those efforts 1,5,6,9,16,20,23,31,36 .…”

“…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.…”

Optimisation of perioperative procedural factors to reduce the risk of surgical site infection in patients undergoing surgery: a systematic review

“…The outcomes analysed were mainly of three types: [22] Average instrument utilisation rate (I used/I total × 100): 27.8% (± 13.1) Optimised tray size: − 57% Dobson et al 2015 [23] 482 (96.4%) cases were solved using the heuristic model Dyas et al 2018 [16] Number of new sets created: 3/13 Number of instruments: 36 (-63%); Farrelly et al 2017 [24] − 9 complete sets − 34% instruments per set − 1 826(-39.5%) instruments processed through the Central Sterile Processing (CSP) unit Farrokhi et al 2013 [25] Reduction in instruments: MIS set: -139 (− 70%) DBS set: − 104 to − 72 (78-80%) Fu et al 2021 [26] Utilisation rate of baseline instruments: 35% Average reduction in the number of instruments: 26% Grodsky et al 2020 [27] − 89% Instruments Number of reopening episodes with the old set = 0 Harvey et al 2017 [28] − 70 (− 19%) instruments number of reopening episodes with the old set = 0 Knowles et al 2021 [30] Utilisation rate per set: 22.9% (vascular set), 12.5% (aortic set) Instrument reduction: − 45.8% (vascular set), − 62.5% (aortic set) Re-opening rate old tray: 0% Koyle et al 2015 [31] Number of instruments not used in Phase I: 69/96 (U); 17/51 in (S) Frequency of use of the non-standardised set in Phase II: 3/52 (6%) Lonner et al 2021 [32] Only 45.5% instruments used; Reduction in instruments after rationalisation: − 32.2% Malone et al 2018 [33] 51 instruments (− 48%) Frequency of reopening with the old set: 0% Nast et al 2019 [35] pre-post utilisation rate: scrotal orchidopexy: 21.1% to 48.2% inguinal orchidopexy with hernia: 41.9% to 71.7% inguinal hernia: 32% to 62.3% reopening rate old tray: 10% Schwartz et al 2021 [36] Utilisation rate: 38% (perceived) vs 55% (observed) Number of instruments: − 49% Set weight: − 33% Shim et al 2021 [37] First tray: 10.6% unused instruments Second tray: 19.6% unused instruments Stockert and Langerman, 2014 [14] Average instrument (± SD) use rates were 13.0% for Otolaryngology (± 4.2%), 15.5% for Plastic Surgery (± 2.9%), 18.2% for Bariatric Surgery (± 5.0%), and 21.9% for Neurosurgery (± 1.7%) Toor et al 2022 [13] Instrumentation measures: Total reduction of instrumentation: 35% Average reduction in set size: 18% Procedure cancellation rate: 3.9% (pre) to 0.2% (post) Satisfaction with surgical instruments (Likert scale 1-4): 1.7% to 80% Van Meter et al 2016 [39] Average number of sets: 5. • reduction of direct and indirect costs related to the procurement, replacement and reprocessing of instrumentation (Table 6).…”

“…One study reported a comparison between the utilisation rate before and after the optimisation of two sets, showing an increase in use of between 27 and 30% [13]. Byrnes et al 2017 [18] Estimated savings in processing costs: $9.69/set Estimated total savings: 5.7% Cichos et al 2017 [15] Estimated savings: thoracotomy, $96; robotic procedure, $84; mediastinoscopy, $77; VATS, $55 Estimated total savings: $69 412/year Cichos et al 2019 [21] Estimated average annual cost savings per set: $24 634 Dobson et al 2015 [23] Estimated savings: + 1.9% over the minimum theoretical cost Dyas et al 2018 [16] Cost savings per intervention: $31.62 ($18.36-$49.98, reprocessing) + $100-$310 (reduced turnover time); Estimated annual savings: $28 458 (reprocessing) + $90 000-$2 790 000 (turnover time reduction) Farrelly et al 2017 [24] Cost reduction: From labour: $3 523.28($-27.88; $2 014.26) (for 6 extensively used sets) by cost avoidance: $106 386 per turnover 5 years estimated savings of indirect costs: $34 693/year Farrokhi et al 2013 [25] Estimated savings: -$2 800 000/year Fu et al 2021 [26] Estimated savings: $9 010/year Grodsky et al 2020 [27] estimated total annual savings per sterilisation: $9 588 John-Baptiste et al 2016 [29] $29 088/year Knowles et al 2021 [30] Estimated annual savings: $97 781 (purchases), $97 444 (processing) Estimated savings of labour time: 316.2 h/year Lonner et al 2021 [32] Estimated annual savings: $281 298.05 Malone et al 2018 [33] Reprocessing costs: -48% (-$23.97) Marchand et al 2020 [34] Annual savings on OT and sterilisation centre processes: $249 245 Nast et al 2019 [35] estimated savings per set: $11.28-70.18 estimated annual savings: $1 525.92-$11 531 Schwartz et al 2021 [36] Lower direct and indirect costs in post compared with that in pre: $93-$539 (p < .0001) Shim et al 2021 [37] Estimated savings from replacement and processing costs: $6 597 Stockert and Langerman 2014 [14] Estimated processing costs: $0.28-0.5/instrument Thiel et al 2019 [17] Direct cost per case: -$125.44 Toor et al 2022 [13] Savings on depreciation costs: $61 395 (considering 8-12 years of use, depending on recommendations) Labour cost savings: $39 995/year Tseng et al 2020 [38] Cost per case: -$123.24 (14.4%, p < .001) Total annual savings: $29 151 Average cost difference between different surgeons: -61% Van Meter et al 2016 [39] Total cost per instrument processing: annual $3.19 per instrument/year Estimation of excess cost from processing of unused instruments: $290 928/year …”