title: Intraoperative waste in spine surgery: incidence, cost, and effectiveness of an educational program.
abstract: METHODS
  Prospective observational study.
  
  
  OBJECTIVE
  This study aims to quantify the incidence of intraoperative waste in spine surgery and to examine the efficacy of an educational program directed at surgeons to induce a reduction in the intraoperative waste.
  
  
  BACKGROUND
  Spine procedures are associated with high costs. Implants are a main contributor of these costs. Intraoperative waste further exacerbates the high cost of surgery.
  
  
  METHODS
  Data were collected during a 25-month period from one academic medical center (15-month observational period, 10-month post-awareness program). The total number of spine procedures and the incidence of intraoperative waste were recorded prospectively. Other variables recorded included the type of product wasted, cost associated with the product or implant wasted, and reason for the waste.
  
  
  RESULTS
  Intraoperative waste occurred in 20.2% of the procedures prior to the educational program and in 10.3% of the procedures after the implementation of the program (P < 0.0001). Monthly costs associated with surgical waste were, on average, $17680 prior to the awareness intervention and $5876 afterwards (P = 0.0006). Prior to the intervention, surgical waste represented 4.3% of total operative spine budget. After the awareness program this proportion decrease to an average of 1.2% (P = 0.003).
  
  
  CONCLUSIONS
  Intraoperative waste in spine surgery exacerbates the already costly procedures. Extrapolation of this data to the national level leads to an annual estimate of $126,722,000 attributable to intraoperative spine waste. A simple educational program proved to be and continues to be effective in making surgeons aware of the import of their choices and the costs related to surgical waste.
authors: Department of Orthopaedic Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Center, Halifax (NS), Canada.
authors: Alex
authors: A
authors: Soroceanu
authors: Elena
authors: E
authors: Canacari
authors: Eric
authors: E
authors: Brown
authors: Adam
authors: A
authors: Robinson
authors: Kevin J
authors: KJ
authors: McGuire
mesh_terms: D000704:Analysis of Variance; D018786:Bone Substitutes / Q000191:economics; D016025:Bone Transplantation / Q000191:economics; D003362:Cost-Benefit Analysis; D004501:Education, Medical / Q000379:methods; D006801:Humans; D015994:Incidence; D007430:Intraoperative Care / Q000191:economics* / Q000706:statistics & numerical data; D008506:Medical Waste / Q000191:economics* / Q000706:statistics & numerical data; D009983:Orthopedic Equipment / Q000191:economics; D019637:Orthopedic Procedures / Q000191:economics* / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D019736:Prostheses and Implants / Q000191:economics; D013122:Spinal Diseases / Q000453:epidemiology / Q000601:surgery; D013131:Spine / Q000601:surgery*; D013997:Time Factors
chemical_list: D018786:Bone Substitutes; D008506:Medical Waste