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SURGICAL INSTRUMENT WASTE IN ELECTIVE COLORECTAL SURGERY: A PROSPECTIVE, INTERVENTIONAL STUDY
Joshua Billings*, Gayane Ovsepyan, Joseph Wend, Karen Zaghiyan, Joy Tang, Phillip Fleshner
Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
Background
Health care facilities in the United States account for more than 4 billion pounds of waste annually. Though costly, little is known about surgical instrument waste during colorectal surgery. We embarked on a prospective study of surgical instrument waste prior to and after informing operating room staff that they would be observed in a cost savings initiative.
Methods
We conducted a prospective, interventional study of surgical waste (sutures, staplers/reloads, sharps, other items) in 50 patients undergoing major colorectal surgery. 35 control cases were observed by a trained medical student who recorded surgical waste acquired during cases due to the initial setup, nursing requests, or surgeon requests. The surgical team was blinded to data monitoring during the initial phase of the study. During the next phase, 15 cases were similarly observed by the medical student after un-blinding the surgical team. Total instruments wasted and cost of wasted instruments were calculated.
Results
Surgical procedures included segmental or total colectomy (n=21), ileal pouch (n=13), low anterior resection (n=5) and other bowel resections (n=11). The mean number of items wasted per case for all 50 cases was 5.3 (sutures [2.2], staplers/reloads [0.6], sharps [0.3], other items [2.2]), with a mean cost per case of $368, accumulating to a total preventable cost of $18,410. When looking at all 50 cases, significantly more items were wasted due to initial setup (2.9) than intra-operative requests by a nurse (1.3; p=0.01) or surgeon (1.1; p<0.01). More total waste accrued in cases requiring dual abdominal and perineal setups than abdominal only (7.6 vs. 3.9; p=0.02) and cases where circulating nurses took more than two breaks (7.8 vs. 3.8; p<0.01). Initial setup waste was higher in cases with dual setups (4.0 vs. 2.2; p=0.04); nursing waste was higher in cases with more than two circulating or scrub nurse breaks (2.8 vs. 0.4; p=0.01; 2.1 vs. 0.7; p=0.04, respectively); and surgeon waste was higher in cases longer than 4 hours (2.2 vs. 0.4; p<0.01). The intervention to increase awareness of data monitoring did not have a significant effect on total wasted items per case (5.5 vs. 4.9 pre- vs. post-intervention; p=0.73), waste by any specific group (initial setup, nurses, or surgeons), or total per-case cost of wasted items ($388 vs. $322 pre- vs. post-intervention; p=0.66).
Conclusion
Surgical waste is common in colorectal surgery and associated with cases requiring multiple setups and more nursing breaks. Furthermore, a large proportion of the waste produced during cases is predetermined due to initial setup dictated by surgical preference cards. Simple interventions to increase surgical waste awareness seem to have little effect.
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