Multipack Versus Single-Sterile Implant Supply in Spine Surgery: A Hospital-Based Health Technology Assessment

Background: Implant supply strategy in spine surgery affects operative workflow, resource utilization, and packaging-related material use, yet has received limited systematic investigation. This study evaluates single-sterile implants versus multipack implants using a hospital-based Health Technology Assessment (HB-HTA) framework. Methods: A non-randomized, mixed-methods comparative study was conducted at a tertiary academic spine center. Time measurements were recorded during eight posterior fusion procedures (four per supply type; n = 18 single-pack screws, n = 20 multipack screws) across three process steps: implant retrieval, sterile transfer, and instrument preparation. Time measurements were recorded per packaging unit; per-implant comparisons were additionally derived for operational interpretation. Packaging volume, weight, and packaging-related CO₂-equivalent estimates were calculated per implant. Standardized questionnaires were distributed to operating-room (OR) nurses (n = 14/21; 66.7%) and institutional surgeons (n = 11/11; 100%). Manufacturer-provided descriptive process and cost data were analyzed. Results: Multipack implants were associated with consistently shorter handling times across all measured process steps. Mean retrieval time per packaging unit was 25.4 s (multipack) versus 58.7 s (single-pack); retrieval time was significantly shorter for multipack units on the Mann-Whitney U test (p = 0.004), a result that was robust to supply-related outlier events (p = 0.001 after their post hoc exclusion). Packaging-normalized sterile-transfer burden per implant was reduced by a factor of 4.76. Instrument preparation was faster with multipack systems (15.6 s vs. 25.2 s). Packaging volume per implant was reduced by a factor of 5.6, and packaging weight by a factor of 2. Packaging-related CO₂-equivalent estimates were lower for multipack implants (0.017 kg vs. 0.026 kg per implant). Survey responses indicated predominantly positive evaluations of workflow and handling efficiency. A trade-off was identified regarding the potential disposal of unused implants (noted by 73% of institutional surgeons). Manufacturer-provided descriptive data suggested scale effects in packaging and sterilization processes. Conclusions: Under high-volume academic conditions, multipack implants were associated with shorter implant-handling process times, favorable staff perceptions, and reduced packaging-related material burden while introducing trade-offs that require local evaluation. These exploratory findings suggest that the implant supply strategy is an underexplored but potentially relevant dimension of surgical process optimization in spine surgery.