Quantifying the U.S. surgical instrument fleet and its reprocessing burden: implications for cost and sustainability in healthcare

BACKGROUND: Reusable surgical instruments require repeated sterilization between procedures, yet many instruments prepared for surgery are never used. The national scale of the reusable surgical instrument fleet and its associated reprocessing burden remain poorly quantified. METHODS: Aggregated operational data from 251 U.S. healthcare facilities encompassing 2,618 operating rooms were analyzed to quantify instrument inventories, sterilization volume, and instrument loss. National estimates were derived by scaling operating room-level metrics to reported U.S. operating room capacity. Published sterilization cost estimates and instrument utilization rates were applied to estimate national sterilization expenditures and idle reprocessing costs. Replacement costs for missing instruments were modeled using log normal price distributions and Monte Carlo simulation. RESULTS: The dataset included 336,784 trays and 6.7 million instruments, with 236 million instruments reprocessed annually. National extrapolation suggests a reusable instrument fleet of approximately 112 million instruments and nearly 4 billion annual reprocessing events. Estimated annual sterilization costs ranged from $1.3 to $11.8 billion. CONCLUSIONS: This study provides an initial estimate of the national cost of surgical instrument reprocessing in the U.S. Further work is required to determine a national estimate of the percentage of instruments that go unused. Nevertheless, the scale of expenditures on this process indicates there will be significant opportunities to improve perioperative efficiency and reduce waste through better inventory management yielding substantial cost savings and decreasing the environmental footprint of surgical care.