Optimizing surgical instrument and implant utilization in orthopedic procedures: A lean methodology approach to cost reduction and efficiency improvement.

Background: Operating rooms (ORs) are among the most resource-intensive areas in hospitals, and optimizing surgical efficiency is crucial for cost reduction. A key contributor to inefficiency is the overstocking of surgical instrument trays and implants, leading to increased sterilization costs, longer processing times, and workflow inefficiencies. Despite its impact, instrument tray optimization has received limited attention in orthopedic surgery.

Methods: This single-center prospective observational study analyzed the utilization rates of surgical instruments and implants in total knee arthroplasty (TKA), total hip arthroplasty (THA), anterior cruciate ligament (ACL) reconstruction, and posterior spinal fusion (PSF) surgeries. Using Lean methodology, unnecessary instruments and implants were identified and removed from standard trays. The effectiveness of this optimization was assessed through comparisons of instrument utilization rates, sterilization costs, and OR preparation times before and after implementation.

Results: A total of 162 procedures were analyzed. Prior to optimization, mean instrument tray utilization rates were low across all procedures (58-65 %), and implant utilization was particularly poor (5-11 %). Post-optimization, significant reductions were observed in the mean number of instrument trays and implants brought into the OR, leading to improved utilization rates (PSF: 67 %, THA: 75 %, ACL: 67 %) and cost savings of up to 1374 JPY per case. The mean intraoperative times unchanged after optimization, while in THA, a notable decrease in intraoperative time was observed (p = 0.022).

Conclusion: Lean-based surgical instrument tray optimization effectively reduces unnecessary material use, lowers sterilization costs up to 1374 JPY per case, without compromising intraoperative times. The estimated annual cost savings for the hospital amounted to 729,575 JPY. Further research on long-term impact is warranted to maximize cost savings and enhance standardization in orthopedic surgeries.