title: Costs associated with instrument sterilization in gynecologic surgery.
abstract: BACKGROUND
  With rising health care expenditures, hospitals must contain costs in ways that maintain high-quality patient care. A significant portion of perioperative costs are associated with materials and supplies; many reusable instruments on surgical trays go unused, which may account for significant annual excess processing costs. Reorganizing gynecologic trays to contain fewer instruments can result in significant cost savings. In the field of operative gynecology, there has been considerable attention to the various costs and surgical outcomes that are associated with hysterectomy performed in the abdominal, vaginal, and laparoscopic approaches; however, little research has been done on the cost differences that are associated with the reusable instruments that are used in these approaches.
  
  
  OBJECTIVE
  This study aimed to identify the percent usage of instruments within gynecologic surgery and to identify differences by surgical approach. We further aimed to estimate the costs of sterilizing surgical instruments and estimate the excess costs that are associated with processing unused instruments.
  
  
  METHODS
  This was a single site observational study. Specific instruments that were used from incision to closure were recorded on operating room count sheets via direct observation of surgeries that were performed in the gynecologic operating rooms by a trained investigator. Cost data on instrument transportation, employee wages, and instrument replacement was obtained from institutional supply chain management.
  
  
  RESULTS
  In total, 28 surgical cases (5 abdominal, 11 laparoscopic, and 12 vaginal) were analyzed, with an average of 2 hours 37 minutes operating room time and 5.4 instrument trays for each case. One hundred fifty trays were observed. Trays had an average of 38 instruments per tray (range, 1-141). Surgeons used an average of 36.7 instruments of 184 available instruments per case, for a usage rate of 20.5±2.8%. A significant difference was noted between usage rates in abdominal cases (26.3±6.5%) and vaginal cases (13.6±3.3%) but not between laparoscopic (19.4±4.2%) vs other approaches. Instrument use was correlated inversely with the number of instruments, with an average usage rate of 18.7% for trays that contained ≥10 instruments. Total annual institutional cost associated with instrument processing was estimated at $3.19 per instrument.
  
  
  CONCLUSIONS
  Instrument usage in the gynecologic operating room is low, and the cost of processing instruments is significant. Availability of certain instruments is necessary for patient safety in the event of rare unexpected events. However, given that less than one quarter of the instruments pulled for surgery are used and that total processing cost per instrument exceeds $3.00, careful review of what instruments are included in each tray is warranted. Clearly, significant cost-savings are possible while concurrently balancing safety concerns.
authors.affiliation: Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN. Electronic address: mary.m.va.meter@vanderbilt.edu.
authors.forename: Mary M
authors.initials: MM
authors.lastname: Van Meter
authors.affiliation: Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Rony A
authors.initials: RA
authors.lastname: Adam
mesh_terms: D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007044:Hysterectomy / Q000191:economics* / Q000295:instrumentation* / Q000379:methods; D061646:Operative Time; D013242:Sterilization / Q000191:economics*; D013525:Surgical Instruments / Q000191:economics* / Q000706:statistics & numerical data; D013714:Tennessee
keywords: costs; gynecology; instrument; sterilization; usage