title: Operative costs, reasons for operative waste, and vendor credit replacement in spinal surgery.
abstract: BACKGROUND
  In 2012, Epstein et al. documented that educating spinal surgeons reduced the cost of operative waste (explanted devices: placed but removed prior to closure) occurring during anterior cervical diskectomy/fusion from 20% to 5.8%.[5] This prompted the development of a two-pronged spine surgeon-education program (2012-2014) aimed at decreasing operative costs for waste, and reducing the nine reasons for operative waste.
  
  
  METHODS
  The spine surgeon-education program involved posting the data for operative costs of waste and the nine reasons for operative waste over the neurosurgery/orthopedic scrub sinks every quarter. These data were compared for 2012 (latter 10 months), 2013 (12 months), and 2014 (first 9 months) (e.g. data were normalized). Savings from a 2013 Vendor Credit Replacement program were also calculated.
  
  
  RESULTS
  From 2012 to 2013 and 2014, spinal operative costs for waste were, respectively reduced by 64.7% and 61% for orthopedics, and 49.4% and 45.2% for neurosurgery. Although reduced by the program, the major reason for operative waste for all 3 years remained surgeon-related factors (e.g. 159.6, to 67, and 96, respectively). Alternatively, the eight other reasons for operative waste were reduced from 68.4 (2012) to 12 (2013) and finally to zero by 2014. Additionally, the Vendor Replacement program for 2013 netted $78,564.
  
  
  CONCLUSIONS
  The spine surgeon-education program reduced the costs/reasons for operative waste for 2012 to lower levels by 2013 and 2014. Although the major cost/reasons for operative waste were attributed to surgeon-related factors, these declined while the other eight reasons for operative waste were reduced to zero by 2014.
authors.affiliation: Department of NeuroScience, Chief of Neurosurgical Spine and Education, Winthrop University Hospital, Mineola, NY 11501, USA.
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Epstein
authors.affiliation: Vice President Operative Services, Winthrop University Hospital, Mineola, NY 11501, USA.
authors.forename: Rita
authors.initials: R
authors.lastname: Roberts
authors.affiliation: Chief Executive Officer, Winthrop University Hospital, Mineola, NY 11501, USA.
authors.forename: John
authors.initials: J
authors.lastname: Collins
keywords: Cost operative waste; education program; nine reasons; spine surgeon; surgeon-related factors; vendor replacement program