title: The economic impact of individually packaged screws.
abstract: BACKGROUND
  Trends in orthopaedic surgery have seen a migration towards using individually packaged screws (IPS). The manufacturers claim IPS improves sterility, traceability, and avoids the effects of repeated sterilisation. In recent times there has been increasing pressure on the NHS to be more cost-efficient. Challenging decisions must be made to make cost-efficient choices without comprising the quality of care provided.
  
  
  OBJECTIVE
  This study investigates the cost-benefit of IPS compared to the conventional screw rack stored screws (SRSS).
  
  
  METHODS
  A single-centred observational study was carried out in a district general hospital between February and March 2013. One-hundred and forty-seven screws were requested intra-operatively and the screw acquisition time was measured with a digital handheld timer. Screw acquisition time was defined as the time taken from the initial verbal request to when the screw was mounted ready for use. The screws were categorised into two groups: SRSS and IPS.
  
  
  RESULTS
  The mean screw acquisition time for the SRSS group (n = 94) was 6.6 s (S.D ± 2.5). The mean screw acquisition time for the IPS group (n = 53) was 102.1 s (S.D ± 25.7). The mean difference between SRSS and IPS was 96 s (95%CI 90.3-100.8; p < 0.001).
  
  
  CONCLUSIONS
  Our study suggests that the use of IPS significantly (p < 0.001) increases the operation duration and costs compared to SRSS. Based on ankle ORIF procedures alone, the use of IPS could potentially increase department spending by approximately £76,680 per year.
authors.affiliation: Trauma and Orthopaedics Department, Royal Gwent Hospital, Cardiff Road, Gwent NP20 2UB, UK. Electronic address: wingyum@gmail.com.
authors.forename: Wing Yum
authors.initials: WY
authors.lastname: Man
authors.affiliation: Trauma and Orthopaedics Department, Royal Gwent Hospital, Cardiff Road, Gwent NP20 2UB, UK.
authors.forename: Ashok
authors.initials: A
authors.lastname: Mukherjee
authors.affiliation: Trauma and Orthopaedics Department, Royal Gwent Hospital, Cardiff Road, Gwent NP20 2UB, UK.
authors.forename: Paul Yuh
authors.initials: PY
authors.lastname: Feng Lee
mesh_terms: D001863:Bone Screws / Q000191:economics*; D003362:Cost-Benefit Analysis; D006801:Humans; D019637:Orthopedic Procedures / Q000191:economics / Q000295:instrumentation*; D019064:Product Packaging / Q000191:economics* / Q000379:methods*; D011446:Prospective Studies; D013222:State Medicine; D013997:Time Factors; D006113:United Kingdom
keywords: Cost-benefit; Economic; Individually packaged screws; Screws; Sterilisation