Reducing Waste During Midurethral Slings: A Quality Improvement Initiative.

Importance: The health care industry accounts for 8.5% of U.S. greenhouse gas emissions, with operating rooms being key contributors.

Objective: The objective of this study was to decrease surgical waste during synthetic midurethral sling (MUS) surgical procedures.

Study design: A quality improvement initiative was implemented to decrease the amount of MUS surgical waste. Waste audits were performed during 20 isolated MUS surgical procedures. Used and unused disposable items and nondisposable instruments were documented from the original packs/trays. All disposable waste was weighed after the completion of each procedure. The utilization rate of each instrument and item were determined. The MUS surgical tray was then updated, and a custom MUS surgical pack was created to include items with a utilization rate >20%. The primary and secondary outcome was the amount of waste generated and health care savings, respectively.

Results: A total of 10 of 21 nondisposable instruments on the surgical tray and 7 of 26 disposable items from the surgical pack had a utilization rate <20% during the initial waste audits. There were 12 of 15 added disposable items that had a utilization rate >20%. Preaudit, median weight of waste per case was 5.6 kg. After updating the MUS surgical trays and packs, median weight of waste per case decreased to 4.9 kg (P = 0.04). On average, $348.93 was saved per case after creation of custom surgical packs that included disposable items specific to MUS surgical procedures.

Conclusion: A waste audit with pack updates and health care team education significantly reduced the amount of waste and cost generated during MUS surgery.