Protocol for the systematic reduction of sterile surgical instrument waste: a single-institution prospective...

Waste accounts for up to 25% of United States healthcare expenditures. Many sterilized surgical instruments remain unused during procedures, contributing to this burden. Reducing the quantity of unused surgical instrumentation presents an opportunity to decrease costs while improving operating room efficiency. This study aimed to characterize instrument utilization patterns and implements a novel, systematic, replicable protocol to eliminate excess sterile instrumentation.

This prospective, single-center study investigated sterile instrumental utilization rates (IURs) across and within procedures. Craniotomy for tumor was used to characterize instrument utilization patterns on a per-surgeon, per-surgery, and per-instrument level. A novel 3-phase protocol was designed to systematically reduce sterile surgical waste. In phase 1, IURs were calculated by dividing the instruments used during a procedure by the number provided. Instruments used in fewer than 20% of cases were removed in phase 2. Streamlined instrument kits were demoed while the original kit remained at hand, and instruments were replaced as requested. Phase 3 represented full integration of the reduced kits with removal of the original kits. IURs and the number of instruments used were compared before and after protocol implementation. The protocol was implemented in 17 additional surgical procedures. Follow-up data were collected over 1 year after instrument kit reduction.

The authors observed 69 cases across 6 procedures. Procedural IURs ranged from 11.3% to 38.4%. Most instrument types remained infrequently used (< 20%) across procedures. In craniotomy for tumor, IUR among the pilot instrument kit ranged from 30.6% to 35.3% (median 33.4%) with no significant variation in the number of instruments used per case (p = 0.88). Following protocol implementation, craniotomy instrument kits were reduced from 157 to 99 instruments. IUR increased to 55.2% (p < 0.001) with no change in the number of instruments used per case (mean 52.2 ± 5.4 preintervention vs 54.4 ± 5.0 postintervention, p = 0.43). The number of infrequently used instruments decreased from 38 to 10. Applied to 18 procedure types across 11 surgical specialties, the protocol reduced kit sizes by 21%-60% (median 38%). No changes to reduced instrument kits were requested following implementation.

Instrument utilization is consistent between surgeons and cases. The systematic elimination of unused sterile surgical instrumentation can therefore reduce surgical waste through a replicable protocol without impacting surgeon instrument selection.