Hospital / Ambulatory Surgical Center Cost Savings: Total Knee Arthroplasty Instrument Tray Reduction Strategy

INTRODUCTION Independent of the surgery type, instrument tray optimization has become a focus of cost-reduction strategies for hospitals and ambulatory surgery centers (ASC). Mhlaba, et al, have shown that the average cost to process a single surgical instrument is approximately $0.51, which may be used to estimate the cost of procedure specific, post-operative surgical instrument processing. The purpose of this study is to introduce an intra-operative instrument tray reduction strategy, specific to a primary total knee arthroplasty (TKA) system, and to report on the influence of the instrument tray reduction implementation on related facility cost reductions. MATERIALS AND METHODS A prospective, continuous series of 34 primary TKAs in 34 patients was performed by a single surgeon. Patient pre-operative co-morbidities were tallied to show that this consecutive series was not selective and included all-comers through the ASC, and following the primary TKA procedure, all patients were discharged the same day of surgery. Patient demographics were recorded, and follow-up through 90 days, 1-, and 2-years were recorded for unscheduled office / hospital visits, and adverse events. In addition, common TKA-specific trays and instrument counts were assessed for processing cost comparisons and cost reduction. RESULTS There were 34 patients studied, and all patients achieved relief of pain and restoration of function through two-years post-operatively. Two patients (2:34, 6%) required unscheduled office visits prior to 90 days for superficial wound care that was resolved without further issue in each. Our instrument tray reduction strategy utilized one (1) tray and 108 TKA-specific instruments, and all pre-operative size recommendations agreed with the intra-operative component size selected and implanted. We compared the single tray system to four common commercial TKA systems which included from 9 to 14 trays and ranged from 278 to 350 TKA specific instruments. The single tray reduced instrument processing cost was calculated at $55 and was significantly less than the other four ranging from $142 to $179. When extrapolated across the 300 TKA cases performed at our ASC in the prior year, the tray reduction system would have yielded an approximate savings range between $26,00 and $37,000 versus the four common TKA systems. CONCLUSION Our results have shown significant processing cost reductions for the proposed instrument tray when compared to various competitive standard TKA specific instrument tray utilization. We recommend that further study with larger numbers is necessary. In addition, this application is warranted to study the further impact on operative room efficiencies including room set-up, turn-over, and the cost per square footage of instrument tray storage.