Associate Professor of Neurosurgery University of Pennsylvania University of Pennsylvania Philadelphia, Pennsylvania, United States
Disclosure(s):
Zarina S. Ali, MD: No financial relationships to disclose
Introduction: Operating rooms (OR) are a major center of waste generation and energy usage in modern hospitals. OR sustainable improvement studies have traditionally focused on one of two efforts: surgical tray optimization or waste management. Available literature detailing the specific implementation of these initiatives is scarce. This quality improvement (QI) study implemented a comprehensive strategy of optimizing waste segregation and surgical instrument inventory in neurosurgery ORs and measured the effects.
Methods: This study was conducted at a tertiary health center from May to October 2024. Surgical inventory metrics were measured, i.e., instrument count, weight, tray assembly time, and labor costs. Before and after the intervention, the Regulated Medical Waste (RMW) and Non-RMW mass associated with neurosurgical spine cases were measured. A questionnaire was used to measure employee engagement on a seven-point Likert scale from least engaged to most engaged.
Results: A total of 18 neurosurgery trays were reviewed by four neurosurgeons. Instruments deemed rarely used were removed from the trays, resulting in a mean reduction in instrument count of 23% (standard deviation (SD) 9.8%) and a mean reduction in assembly time of 29 minutes (SD 7 minutes) per surgery. Based on these reductions, annual labor cost savings was estimated to be $8000 (SD $1500). Across 68 neurosurgery cases (15 anterior cervical discectomy and fusions, 13 posterior cervical fusions, 19 lumbar laminectomies, 21 thoracolumbar fusions), the ratio of mean RMW to mean Non-RMW decreased from 1.4 (SD 0.3) to 0.8 (SD 0.2). Mean employee engagement increased by 23% (SD 12%) following the intervention (n = 61).
Conclusion : This study demonstrated the feasibility and preliminary success of implementing interventions to improve neurosurgery OR sustainability. Similar QI initiatives can be adopted in other surgical specialties or at other institutions.