1362 Protocol to Reduce Neurosurgical Instrument Waste: Evaluation of a Prospective Single Institution Intervention

INTRODUCTION: US healthcare costs, of which ∼30% are estimated to be waste, account for approximately 18% of the country’s annual gross domestic product. Operating rooms (ORs) contribute a large proportion of this waste, owing to robust sterilization procedures, large amounts of disposable equipment, and unused instrumentation. Reducing surgical waste presents a meaningful opportunity to decrease environmental and operational costs within the healthcare system while improving OR efficiency. METHODS: IURs were measured across six procedure types and four specialties (neurosurgery, CT surgery, OMFS, and urology). Craniotomy for Tumor was chosen as a pilot procedure for intervention implementation by five neurosurgeons. A systematic approach to remove infrequently used, non-essential instruments from basic craniotomy kits was employed. Pre- and post-intervention IURs were compared, and a cost analysis was performed. RESULTS: Eighty-nine cases across six procedure types and four specialties were observed. Pre-intervention IURs were similar across all (average IUR = 25.5%, n=69). The Craniotomy for Tumor intervention observed in 20 cases significantly increased the IUR overall (25.1% vs 55.5%, p<0.001) and across each surgeon. Since implementation in August 2022, there have been zero requests to replace removed instruments. Estimating an average cost of $0.83/instrument for instrument maintenance and sterilization, this reduction in surgical waste is estimated to generate a cost savings of $111,805.57/year for this procedure type alone. CONCLUSIONS: Applied across multiple specialties with similar low IURs, analogous protocols have the potential to provide substantial improvements in OR efficiency and cost savings within the healthcare system. This study, monitored over a 2-year implementation period, supports the long-term stability of this solution to reduce surgical instrumentation waste.