P148. Single-use versus reusable instrumentation for lumbar fusion surgery: a cost savings analysis

Abstract

BACKGROUND CONTEXT Instrumentation for surgery can be a significant contributor to high costs associated with spine procedures. Traditional, reusable instruments require sterilization and reprocessing for their next surgery, whereas single-use systems offer the advantage of avoiding those steps. However, little is currently known regarding the difference in time and resources between these two systems. PURPOSE To compare the instrumentation-related cost of single-use vs reusable instrument trays. STUDY DESIGN/SETTING Prospective cohort study. PATIENT SAMPLE Patients undergoing lumbar decompression and single-level fusion surgeries were prospectively enrolled at a large academic hospital between July 2017–October 2018. Twenty patients were enrolled in the single-use instrumentation group vs 20 patients in the reusable instrumentation group. OUTCOME MEASURES Time spent handling instruments per case, total cost of instrumentation per case. METHODS A single observer recorded the total time spent for instrument handling, opening, setup and restocking by direct observation and using a hand-held stopwatch. The variable per-case cost associated with reusable instrumentation was calculated as: Costresuable = CostOR +CostSPD, where CostOR is the number of hours instruments that were handled multiplied by the OR nurse hourly salary and CostSPD is the cost of reprocessing an instrumentation tray in the sterile processing department (SPD). Single-use instrumentation did not require reprocessing, so the variable Costsingle-use = CostOR. Independent samples t-tests or Chi-squared/Fisher's exact tests were used to determine differences for continuous and categorical data, respectively. RESULTS There were no significant baseline differences between groups (p >0.05). The mean time from opening of instrumentation to use was 158.4±48.5 minutes for the reusable group compared to 40±6.5 min (p =0.0008) for the single-use group. The mean time of handling reusable instruments by the OR nurse was 11.6±3.9 minutes, compared to 2.1±0.5 minutes for single-use instruments (p CONCLUSIONS In this study, single-use instrumentation provided significantly greater cost savings when compared to reusable instrumentation that is independent of the cost of the instrumentation. Additionally, there was significantly reduced time from the opening of instrumentation to use in surgery for the single-use system, potentially limiting contamination in the surgical field. Further prospective studies are needed to explore this relationship. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.