title: Operating room waste: disposable supply utilization in neurosurgical procedures.
abstract: OBJECTIVE Disposable supplies constitute a large portion of operating room (OR) costs and are often left over at the end of a surgical case. Despite financial and environmental implications of such waste, there has been little evaluation of OR supply utilization. The goal of this study was to quantify the utilization of disposable supplies and the costs associated with opened but unused items (i.e., "waste") in neurosurgical procedures. METHODS Every disposable supply that was unused at the end of surgery was quantified through direct observation of 58 neurosurgical cases at the University of California, San Francisco, in August 2015. Item costs (in US dollars) were determined from the authors' supply catalog, and statistical analyses were performed. RESULTS Across 58 procedures (36 cranial, 22 spinal), the average cost of unused supplies was $653 (range $89-$3640, median $448, interquartile range $230-$810), or 13.1% of total surgical supply cost. Univariate analyses revealed that case type (cranial versus spinal), case category (vascular, tumor, functional, instrumented, and noninstrumented spine), and surgeon were important predictors of the percentage of unused surgical supply cost. Case length and years of surgical training did not affect the percentage of unused supply cost. Accounting for the different case distribution in the 58 selected cases, the authors estimate approximately $968 of OR waste per case, $242,968 per month, and $2.9 million per year, for their neurosurgical department. CONCLUSIONS This study shows a large variation and significant magnitude of OR waste in neurosurgical procedures. At the authors' institution, they recommend price transparency, education about OR waste to surgeons and nurses, preference card reviews, and clarification of supplies that should be opened versus available as needed to reduce waste.
authors.affiliation: Department of Neurological Surgery.|Center for Healthcare Value.
authors.forename: Corinna C
authors.initials: CC
authors.lastname: Zygourakis
authors.affiliation: Brown University, Providence, Rhode Island.
authors.forename: Seungwon
authors.initials: S
authors.lastname: Yoon
authors.affiliation: Center for Healthcare Value.|Division of Hospital Medicine.
authors.forename: Victoria
authors.initials: V
authors.lastname: Valencia
authors.affiliation: Center for Healthcare Value.|Department of Medicine, and.
authors.forename: Christy
authors.initials: C
authors.lastname: Boscardin
authors.affiliation: Center for Healthcare Value.|Division of Hospital Medicine.
authors.forename: Christopher
authors.initials: C
authors.lastname: Moriates
authors.affiliation: Center for Healthcare Value.|Department of Medicine, and.|Continuous Process Improvement, University of California, San Francisco, California; and.
authors.forename: Ralph
authors.initials: R
authors.lastname: Gonzales
authors.affiliation: Department of Neurological Surgery.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Lawton
mesh_terms: D000328:Adult; D004209:Disposable Equipment / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D019635:Neurosurgical Procedures / Q000191:economics* / Q000295:instrumentation*; D009873:Operating Rooms / Q000191:economics*; D012495:San Francisco
keywords: IQR = interquartile range; OR = operating room; UCSF = University of California, San Francisco; disposable surgical supplies; operating room; supply utilization; surgical cost