Optimizing spine surgery instrument trays to immediately increase efficiency and reduce costs in the operating room

Background: Surgical tray configurations are rarely audited, which results in an often-overlooked source of perioperative inefficiency and unnecessary costs. The challenge in determining the ideal contents of a tray lies in the balance between clinical needs, costs, ease of batching, prevention of adverse clinical events and minimization of wear and tear. In our study, we developed a novel hybrid approach (HA) based on surveys and cost analyses to reduce the number of instruments on the laminectomy tray (LT) and the basic neurosurgery tray (BNT). We compared the reduction in the number of instruments as well as cost savings from our approach to 2 approaches previously described in the literature: clinician review (CR) and mathematical optimization (MO). Methods: Three approaches were tested: MO, CR and HA. A MO was performed via the mathematical analysis of 25 observations of the use of a LT and BNT tray. For the CR and HA approaches, we interviewed 5 neurosurgeons and 3 orthopedic surgeons who performed a total of 5437 spine cases, requiring the use of the LT and BNT, from Apr. 1, 2017, to Feb. 15, 2021, at Sunnybrook Health Sciences Centre. In the CR approach, surgeons suggested which surgical instruments should be removed. The HA approach was performed via a structured survey of the surgeon's estimated instrument usage, followed by a cost-based inflation point analysis. Results: The MO, CR and HA resulted in a total instrument reduction of 38%, 41% and 35%, respectively. Similarly, the total cost savings per annum were $44 417.60, $50 211.20 and $46 348.80, respectively. Conclusion: While hospitals continue to examine perioperative services for potential inefficiencies, surgical inventory will be increasingly scrutinized. Despite MO being the most accurate methodology to do so, our results suggest that savings were similar across all 3 methods. CR and HA are significantly less laborious and thus are viable alternatives.