Reducing surgical instrument usage: systematic review of approaches for tray optimization and its advantages on environmental impact, costs and efficiency.

Background: Operating rooms generate substantial waste and budget expenditure due to extensive material usage. Reusable instruments are often packaged in trays, which accumulate instruments over time. This review quantifies the advantages of tray optimization (removing redundant instruments), including reduced environmental impact, costs, operating room and processing time.

Methods: Following PRISMA guidelines, searches were conducted in PubMed, Embase, Web of Science and The Cochrane Library in August 2024 for studies on optimizing surgical trays in human surgeries. Studies were included if they reported on optimization approaches and outcomes related to environmental, economic or efficiency improvements. Exclusions included studies on disposable instruments, animal or veterinary research and patient-specific trays. Risk of bias was assessed using the ROBINS-I (Risk Of Bias In Non-randomised Studies - of Interventions) tool.

Results: The search identified 4511 studies, with 45 meeting the inclusion criteria. Half of the studies showed a serious risk of bias, while the rest had a moderate risk. Three main optimization strategies were identified, with expert analysis being the most common (n = 29), followed by mathematical modelling. Environmental benefits were reported in all three included studies, although limited in number. Studies reported that 19 to 89% of instruments could be removed from trays, with 31 studies unanimously reporting cost reductions. Additionally, 17 studies demonstrated improved operational efficiency.

Conclusion: Tray optimization strategies effectively reduce resource use, resulting in environmental and economic benefits. Although no standard method exists, effective strategies such as procedure observation and clinician feedback may eliminate over half of the instruments, offering a significant opportunity to minimize resource consumption in the operating room.