Single-Use Reamer Shafts for Intramedullary Nail Fixation: An Addressable Source of Extraneous Cost and Medical Waste in Orthopaedic Surgery

Abstract

Objectives: To analyze the impact of switching from single-use reamer shafts to reusable reamer shafts for intramedullary nail fixation (IMN) of femur and tibia fractures at a single level-one trauma center, in terms of cost, metal waste, and infection rates. Design: Retrospective comparison study Setting: Level one trauma center Patients/Participants: Patients with operative femur and tibia fractures treated before and after adoption of a reusable reamer shaft. Intervention: Reamed IMN fixation Main Outcome Measurements: Reductions in cost ($292 per shaft) and metal waste (0.44 pounds (lbs) per reamer shaft; reamer shaft failure (breakage and/or incarceration); superficial and deep infections Results: A single surgeon treated 125 and 135 fractures before and after adoption of a reusable reamer shaft. No reamer shaft failures were identified. The before and after groups did not differ in age, OTA/AO classification, or infection rates. By adopting reusable reamer shafts the surgeon avoided an estimated 54 single-use reamer shafts per year for an estimated cost and metal waste savings per year of $15,643 USD and 24 lbs. Over the same time period that the surgeon switched to using reusable reamer shafts, a total of 283 single-use reamer shafts were utilized by 12 surgeons in the same department. If the entire department had adopted reusable reamer shafts during that time period an estimated 164 reamer shafts per year would have been avoided for a total cost and metal waste savings per year of $47,763 USD and 72 lbs. Discussion: Single-use reamer shafts represent an easily addressable source of extraneous cost and metal waste in orthopaedic surgery. Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Using Preference Cards to Support a Thoughtful, Evidence-based Orthopaedic Surgery Practice

“…35 Reusable items are consistently found to reduce both financial and waste burden over disposable equivalents, and many are preferred by surgeons and techs for reasons of ergonomics, accuracy, and handling. [36][37][38] Figure 2 Image displays the trays requested for a pediatric ACL reconstruction case. The 11 trays and sterile wrapped items outlined in green on the right are consistently used for each ACL reconstruction case.…”