Reusable Instruments Research Articles

Partnering with Central Sterile Processing Department Experts to Advance Infection Prevention Competency

<h3>Background</h3> The Central Sterile Processing Department (CSPD) manages the cleaning, disinfection, and sterilization of reprocessed devices and instruments. Infection Preventionists (IP) work closely with CSPD to ensure devices and instruments are reprocessed and stored according to the recommendations of manufacturer, regulatory, and expert guidelines. A large healthcare system surveyed their IP and identified opportunities related to the updated Association for Professionals in Infection Control and Epidemiology (APIC) Competency Model (2019) domains. Cleaning, Disinfection and Sterilization falls under the Operations domain and was identified as an area in which IP wanted to enhance their expertise. <h3>Methods</h3> IP partnered with CSPD experts throughout the healthcare system to provide an in-depth education workshop to grow IP competency in CSPD. IP within our system are responsible for CSPD in a range of settings, including adult and pediatric acute care, critical access hospitals, ambulatory surgery centers, and over 120 physician offices or outpatient care areas. The workshop was divided into 4 sessions that consisted of oral presentations, hands-on learning, and discussion of examples and real-life scenarios. Manufacturer instructions for use (MIFU) were addressed, and a review of standard work and best practices due to sterilization failures were discussed. <h3>Results</h3> 32 attendees from 12 settings participated in the workshop, including Infectious Diseases (ID) physicians, IP, Occupational Health (OH) practitioners, and CSPD technicians. Attendees were asked to evaluate the quality of the educational sessions. 20 attendees completed their evaluations. The 4 sessions each received either an Agree (12) or a Strongly Agree (68) approval rating. The overall quality of the program received an Excellent (16) or a Good (4). <h3>Conclusions</h3> By partnering with CSPD subject matter experts (SME) from their healthcare facilities, IP, ID Physicians and OH Specialists increased their knowledge about the cleaning, disinfection, and sterilization of reusable devices and instruments and enhanced their professional relationships with their CSPD team.

Single Use Instruments for Implanting a Contemporary Total Knee Arthroplasty System Are Accurate, Efficient, and Safe

BackgroundSingle use instruments (SUI) is a potential mechanism to improve efficiency and reduce cost in total knee arthroplasty (TKA). New technology requires patient safety and surgical accuracy. A multi-center study of SUI vs reusable mechanical instrumentation (RUI) for a TKA system compared implant placement accuracy and operating room (OR) efficiency. MethodsFour surgeons implanted 88 primary TKAs, N = 44 RUI and N = 44 SUI. Accuracy was measured radiographically at 3 months. The primary endpoint was non-inferiority of absolute value of mechanical axis alignment. Radiographic endpoints, OR times, and adverse events were also evaluated. ResultsSeventy-five subjects completed the study (41 SUI/34 RUI). The primary endpoint non-inferiority of SUI vs RUI was met, with no significant difference between SUI and RUI in most radiographic parameters (distal femoral varus-valgus, proximal tibial varus-valgus, tibial slope, or subjects within 3° of target); there was a slight difference in femoral component flexion angle (P = .015). SUI and RUI mean (SD) OR set-up times were 18.8 (10.03) and 26.7 (6.93) (P <.001), and surgical times (first incision to last stitch) were 64.6 (16.95) and 60.5 (19.01) (P = .295), respectively. Differences in OR clean-down and anesthesia were not significant. There were no revisions, and there was no significant difference in the number of reported adverse events. ConclusionSUI resulted in similar accuracy of implant placement to RUI with decreased OR set-up time and no increase in adverse events. These results support the safety and efficacy of SUI for performing TKA. Further analysis of potential economic and technical advantages is warranted.

Processing and Handling Cost of Single-use Versus Traditional Instrumentation for 1 Level Lumbar Fusions.

A single center, observational prospective clinical study. The aim of this study was to compare the instrumentation-related cost and efficiency of single-use instrumentation versus traditional reusable instrument trays. Single-use instrumentation provides the opportunity to reduce costs associated with cleaning and sterilizing instrumentation after surgery. Although previous studies have shown single-use instrumentation is effective in other orthopedic specialties, it is unclear if single-use instrumentation could provide economic advantages in spine surgery. A total of 40 (20 reusable instrumentation and 20 single-use instrumentation) lumbar decompression (1-3 level) and fusion (1 level) spine surgeries were collected. Instrument handling, opening, setup, re-stocking, cleaning, sterilization, inspection, packaging, and storage were recorded by direct observation for both reusable and single-use instrumentation. The rate of infection was noted for each group. Mean time of handling instruments by the scrub nurse was 11.6 (±3.9) minutes for reusable instrumentation and 2.1 (±0.5) minutes for single-use instrumentation. Mean cost of handling reusable instruments was estimated to be $8.52 (±$2.96) per case, and the average cost to reprocess a single tray by Sterilization Processing Department (SPD) was $58. Thus, the median cost for sterilizing 2 reusable trays per case was $116, resulting in an average total Costresuable of $124.52 (±$2.96). Mean cost of handling single-use instrumentation was estimated to be $1.57 ($0.38) per case. Single-use instrumentation provided greater cost savings and reduced time from the opening of instrumentation to use in surgery when compared with reusable instrumentation.

Analysis of an improved workflow of endoscope reprocessing for bedside endoscopic diagnosis and treatment on COVID-19 patients.

Severe cases infected with the coronavirus disease 2019 (COVID-19), named by the World Health Organization (WHO) on Feb. 11, 2020, tend to present a hypercatabolic state because of severe systemic consumption, and are susceptible to stress ulcers and even life-threatening gastrointestinal bleeding. Endoscopic diagnosis and treatment constitute an irreplaceable part in the handling of severe COVID-19 cases. Endoscopes, as reusable precision instruments with complicated structures, require more techniques than other medical devices in cleaning, disinfection, sterilization, and other reprocessing procedures. From 2016 to 2019, health care-acquired infection caused by improper endoscope reprocessing has always been among the top 5 on the list of top 10 health technology hazards issued by the Emergency Care Research Institute. Considering the highly infective nature of COVID-19 and the potential aerosol contamination therefrom, it is of pivotal significance to ensure that endoscopes are strictly reprocessed between uses. In accordance with the national standard “Regulation for Cleaning and Disinfection Technique of Flexible Endoscope (WS507-2016),” we improved the workflow of endoscope reprocessing including the selection of chemicals in an effort to ensure quality control throughout the clinical management towards COVID-19 patients. Based on the experience we attained from the 12 severe COVID-19 cases in our hospital who underwent endoscopy 23 times in total, the article provides an improved version of endoscopic reprocessing guidelines for bedside endoscopic diagnosis and treatment on COVID-19 patients for reference.

MP63-16 DISPOSABLE VERSUS REUSABLE URETEROSCOPES

INTRODUCTION AND OBJECTIVE:Ureteroscopy with laser lithotripsy is a commonly performed stone removal procedure. As with any reusable instrument, increased usage is associated with increased wear an...

MP69-06 THE IMPACT OF SINGLE-USE DIGITAL FLEXIBLE CYSTOSCOPE FOR DOUBLE J REMOVAL ON HOSPITAL COSTS AND WORK ORGANIZATION IN DIFFERENT HEALTH SYSTEMS WORLDWIDE: A MULTICENTRIC EVALUATION

You have accessJournal of UrologyStone Disease: Surgical Therapy VII (MP69)1 Apr 2020MP69-06 THE IMPACT OF SINGLE-USE DIGITAL FLEXIBLE CYSTOSCOPE FOR DOUBLE J REMOVAL ON HOSPITAL COSTS AND WORK ORGANIZATION IN DIFFERENT HEALTH SYSTEMS WORLDWIDE: A MULTICENTRIC EVALUATION Marco Oderda, Jean Delarosette, Steve Doizi, Vincent Estrade, Marco Falcone, Ben Grey, Bodo Knudsen, Jonathon Olsburg, Nick Rukin, and Paolo Gontero* Marco OderdaMarco Oderda More articles by this author , Jean DelarosetteJean Delarosette More articles by this author , Steve DoiziSteve Doizi More articles by this author , Vincent EstradeVincent Estrade More articles by this author , Marco FalconeMarco Falcone More articles by this author , Ben GreyBen Grey More articles by this author , Bodo KnudsenBodo Knudsen More articles by this author , Jonathon OlsburgJonathon Olsburg More articles by this author , Nick RukinNick Rukin More articles by this author , and Paolo Gontero*Paolo Gontero* More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000949.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Isiris® is a single-use digital flexible cystoscope that allows JJ removal outside of a dedicated endoscopy room (EnR) or operatory room (OR). The main challenge regarding this new technology is its impact on the cost. Since this endoscope is single-use, it does not require a dedicated place for stent removal, cleaning and storage, the only direct costs are the one of Isiris™ itself. Aim of this study was to conduct a multicentric evaluation of the costs and criticalities of JJ removal procedure performed with Isiris™ in different hospitals and health systems, as compared to other JJ removal procedures. METHODS: After gathering several institutions worldwide with experience on Isiris®, we performed an analysis of the costs related to JJ removal with Isiris®, according to the different hospital settings and health systems, and compared to the traditional reusable equipment used in each institution. The cost evaluation included the cost of instrument; EnR/OR occupancy; medical personnel; instrument elimination; maintenance, repairs, decontamination and sterilization of reusable device. RESULTS: Table 1 shows the cost estimates per JJ removal in the institutions included in study. The main factor affecting the costs of the procedure was OR/EnR occupancy (from 250€ to 1.125€ for 30’). Decontamination and sterilization accounted for a small part of total costs but might affect the lifespan of reusable instruments. Isiris™ was more rentable in institutions where JJ removal is usually performed in the EnR/OR, allowing to perform the procedure in outpatient clinic, with a significant saving of money (from 41€ to 1.140£ per procedure) and EnR/OR time that could be dedicated to other activities. Despite the fact that in the only institution where JJ removal is done in outpatient clinics with reusable scopes there was a slight cost benefit in favor of reusable material, Isiris® provides that a sufficient number of cystoscopes is always available to guarantee an effective turnover. CONCLUSIONS: Isiris™ leads to significant cost benefit in the institutions where JJ removal is routinely performed in EnR/OR, both in terms of money saved and EnR/OR time saved for other procedures. Source of Funding: Unrestricted grant from Coloplast © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1046-e1046 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marco Oderda More articles by this author Jean Delarosette More articles by this author Steve Doizi More articles by this author Vincent Estrade More articles by this author Marco Falcone More articles by this author Ben Grey More articles by this author Bodo Knudsen More articles by this author Jonathon Olsburg More articles by this author Nick Rukin More articles by this author Paolo Gontero* More articles by this author Expand All Advertisement PDF downloadLoading ...

Life cycle assessment of a disposable and a reusable surgery instrument set for spinal fusion surgeries

The worldwide increasing wealth and increased life expectancy of humans has led to an increase in the number of medical procedures and surgeries. Surgeries are complex medical procedures which contribute to a significant share of the total environmental impact of the healthcare system. Among other important sources of environmental impacts from surgeries, material consumption due to required instrumentation accounts for up to 65 % of greenhouse gas emissions from surgeries. This study investigates how a disposable and a reusable surgery instrument sets for lumbar fusion surgeries contribute to the environmental impact and which system is more advantageous for the environment. For lumbar fusion surgeries, reusable and disposable instrumentation and implant sets are commercially available. Both sets are capable to support a one level lumbar fusion surgery. The reusable set is comprehensive and fully opened before the surgery, while the disposable system comes in a modular box system, and the boxes are opened on demand during the surgery. To compare the environmental impact of these different configurations, a comparative Life Cycle Assessment (LCA) was performed to assess the overall environmental impacts of both alternatives. One of the key findings is that the selected cleaning and sterilization process for reusable instruments is responsible for up to 90 % of the greenhouse gas emissions and decides which system is advantageous from an environmental perspective. Reducing the number of instruments to be cleaned and sterilized for a surgery should be the focus for future surgery instruments development from an environmental perspective.

Can a simple ‘cost-awareness’ campaign for laparoscopic hysterectomy change the use and costs of disposable surgical supplies? Pre–post non-controlled study

ObjectivesDoes a cost-awareness campaign for gynaecologists lead to a change in use and costs of disposable surgical supplies for laparoscopic hysterectomy (LH) without increasing hospital utilisation measures (operating room (OR)...

Initial Experience With a New Robotic Surgical System for Cholecystectomy.

Background. Laparoscopic cholecystectomy has been the gold standard treatment for symptomatic cholelithiasis for more than 3 decades. Robotic techniques are gaining traction in surgery, and recently, the Senhance™ robotic system was introduced. The system offers advantages over other robotic systems such as improved ergonomics, haptic feedback, eye tracking, and usability of standard laparoscopic trocars and reusable instruments. The Senhance was evaluated to understand the feasibility, benefits, and drawbacks of its use in cholecystectomy. Study Design. A prospectively maintained database of the first 20 patients undergoing cholecystectomy with the Senhance was reviewed at a single hospital. Data including operative time, console time, set up time, and adverse events were collected, with clinical outcome and operative time as primary outcome measures. A cohort of 20 patients having laparoscopic cholecystectomy performed by the same surgeon was used as a comparator group. Results. The 2 groups had comparable demographic data (age, sex, and body mass index). In the Senhance group, 19 of the 20 procedures (95%) were completed robotically. The median (interquartile range) total operating, docking, and console times were 86.5 (60.5-106.5), 11.5 (9-13), and 30.8 (23.5-35) minutes, respectively. In the laparoscopic group, the median (interquartile range) operating time was 31.5 (26-41) minutes. Postoperatively, only one patient had a surgical complication, namely a wound infection treated with antibiotics. Conclusion. Our results suggest that Senhance-assisted cholecystectomy is safe, feasible, and effective, but currently has longer operative times. Further prospective and randomized trials are required to determine whether this approach can offer any other benefits over other minimally invasive surgical techniques.

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

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.

Guideline Implementation: Sterilization.

Ensuring that reusable surgical instruments and medical devices have been sterilized is an important factor in preventing surgical site infections. The sterilization method for a particular device is based on the device design, material, packaging, compatibility with the sterilant, load limitations, and safety requirements. Perioperative team members must review the manufacturer's instructions for cleaning, packaging, and sterilizing the device to determine the correct sterilization process. The AORN "Guideline for sterilization" provides guidance for processing reusable medical devices for use in perioperative and procedural settings. This article elaborates on key takeaways from the guideline, including processing a device based on the intended use of the item, protecting sterile items during transport, reprocessing by immediate-use steam sterilization when certain conditions can be met, and educating personnel who perform sterile processing activities. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

Successful device reprocessing begins at the bedside: A hospital-wide approach to train front-line staff to pre-clean

BACKGROUND: A key component of a successful disinfecting and sterilization program is point-of-use pre-cleaning performed by front-line staff. Ensuring competency of nurses, physicians, and support staff from numerous clinical areas to appropriately perform this task is a challenge. The objective of this initiative was to develop and evaluate an annual hospital-wide education and competency program for staff that perform pre-cleaning of reusable devices. METHODS: In 2017 Infection prevention partnered with perioperative services and central sterile processing departments at a 1250-bed academic medical center to develop a competency training program. A train-the-trainer approach was used for all staff who perform pre-cleaning. Areas using instruments that require pre-cleaning were instructed to send >2 representatives to complete the training. These individuals were then super-users, responsible for training the rest of their department. The training consisted of hands-on training stations to review the pre-cleaning process for various device types. In 2018 a brief overview highlighting the importance of appropriate reusable instrument and device reprocessing and an 8-question pre-/post-test to measure knowledge gain from the training were added to the program. Pre-/post-test results were compared using chi-square analysis. RESULTS: Ninety-five participants from 37 patient care areas attended the 2018 training session, including 58 (61.1%) nurses, 2 (2.0%) physicians, 20 (21.1%) patient care technicians, 10 (10.5%) radiology technicians and 5 (5.3%) other. Mean test scores improved from pre-test to post-test [78.0% vs. 91.6% (p CONCLUSIONS: Implementation of a multidisciplinary hands-on competency training program is an effective way to train staff on pre-cleaning of reusable devices. Overall test scores significantly improved after participants completed the training.

Physician Based Practices and Instrument Sterilization- How do you do it?

BACKGROUND: Establishing an instrument sterilization program for physician-based practices (PBP) that are under a hospital license is an important aspect of a successful outpatient infection prevention (IP) program. PBP's struggle with the space and resources (staff and money) to adequately manage the sterilization of reusable instruments. Our objective is to develop a process that allows the PBP to operate efficiently and effectively but still be compliant with proper instrument reprocessing. METHODS: We created a program that removed all tabletop autoclaves and sterilization practices from the PBPs and provided them a service to have their instruments reprocessed at the hospital's sterile processing department. We obtained locking biohazard bins for the dirty instruments, red carts that housed the bins and green carts that held clean instruments returned to the PBP. We purchased a temperature-controlled truck that had segregated clean and dirty areas that securely held the carts and was only used for the transport of instruments. We established a schedule for pick up and drop off that accommodated each PBP's schedule. We established (up front) a 48?hour instrument turnaround time (TAT) for all practices. We held meetings with each PBP leadership team that discussed expectations of the program. RESULTS: The TAT was the most difficult aspect for the PBPs to manage in the beginning. All practices obtained additional instruments to accommodate the 48-hour TAT. Pick up schedules were adjusted to account for travel time and parking limitations that were not initially recognized. All PBPs effectively relinquished on site instrument sterilization practices without incident. CONCLUSIONS: Removing instrument sterilization from the PBPs provides an effective way to assure compliance with sterilization practices in an outpatient setting. It allows the PBP to concentrate on taking care of their patients and leaves reprocessing of instruments to the hospital sterile processing department.

Logistical and Economic Advantages of Sterile-Packed, Single-Use Instruments for Total Knee Arthroplasty

BackgroundTotal knee arthroplasty (TKA) is well established as a clinically successful and cost-effective procedure. The transition of the US healthcare system from a fee-for-service model to a value-based care model requires careful examination of patient care to ensure both quality and efficiency. Sterile-packed, single-use instruments have been introduced as a tool to help streamline the operating room (OR) logistics while reducing sterilization requirements. The aim of this study was to examine the potential logistic and economic benefits of single-use instruments compared to traditional, reusable instruments for TKA. MethodsFour variables related to TKA costs and logistics were modeled in this study: OR turnover time tray sterilization, tray management time, and 90-day infection rates. Model input data for traditional instruments and single-use instruments were based on peer-reviewed literature. A total of 200 sites and 500 cases per site were simulated using the Monte-Carlo-Technique. ResultsThe median total cost savings with single-use instruments was $994 per case. The largest driver for cost savings was tray sterilization. Sites with higher staff wages and sterilization costs had a larger probability of realizing greater cost savings with adoption of single-use instruments. In cases using single-use instruments, up to 51% of operating days could have accommodated an additional procedure due to the time savings in OR turnover. ConclusionThis cost modeling study observed significant potential for logistical and economic improvements in TKA with single-use vs reusable instruments. Although few studies have been conducted to measure the impact of single-use instruments in practice, the results of these simulations motivate further investigation.

The power of pre-treatment forumlations

Peter Bacon reports on a study proving the positive effect of pre-treatment formulations on re-usable surgical instruments by reducing residual protein before steam sterilisation

Does Cost Influence the Choice of Disposable Versus Reusable Instruments? Mailed Survey of Obstetrician/Gynaecologists.

A "cost-awareness" campaign was undertaken at a tertiary hospital from 2015 to 2016 to raise awareness about costs of disposable versus reusable instruments in laparoscopic procedures. We undertook a before and after survey of obstetrician/gynecologists (Ob/Gyns) to find out if the campaign had affected their attitudes about choosing disposable versus less expensive reusable instruments. In 2015 (before the cost-awareness campaign) and 2017 (after the cost-awareness campaign), all full-time university-associated Ob/Gyns were mailed a cover letter, questionnaire, and coffee card ($5) with a postage-paid return envelope. Responses (with unique identification) from Ob/Gyns who perform laparoscopic procedures were entered into a password-protected REDCap database on a secure server. All statistical analyses were performed using SAS software version 9.4 (SAS Institute Inc, Cary, NC) (Canadian Task Force Classification II-3). A total of 35 of 42 eligible Ob/Gyns (85%) with a median 10 years in practice completed questionnaires before and after the intervention. The majority had undertaken minimally invasive surgery training, mainly during residency (80%) and conferences (71%). Before the intervention, the three most important qualities influencing their decision to use a particular instrument were safety (66%), effectiveness (57%), and personal experience (49%). After the intervention, the three most important qualities were effectiveness (57%), safety (57%), and ease of use (46%). Device cost was ranked sixth (26%) before and seventh (17%) after the intervention. The majority (57%) of participants did not change their choice of disposable or reusable instruments, or they would make the choice according to the specific procedure. Given the current economy, operative costs are constantly under review. Knowledge about Ob/Gyns' attitudes provides information to design more effective awareness campaigns to encourage use of less costly instruments. To change practice, a campaign increasing Ob/Gyns' exposure to less expensive but safe and effective instruments may help to increase uptake and potentially lead to cost reduction. Cost awareness alone is unlikely to change practice.

Effectiveness of using low-temperature coolants in machining to enhance durability of AISI 316L stainless steel for reusable biomedical devices

Austenitic stainless steels are currently used for the manufacture of reusable medical instruments, thanks to their combination of elevated strength, corrosion resistance, biocompatibility and low cost. However, during their service life, they are subjected to repeated sterilization cycles, which lead to the loosening of the surface oxide stability and, thus, decrease their durability.In the present study, the influence of different machining cooling conditions on the in-service corrosion behaviour of the AISI 316L stainless steel is investigated with the aim of increasing its resistance to the sterilization cycles. In particular, the effects of low-temperature coolants, namely Liquid Nitrogen (LN2) and gaseous Nitrogen (N2) cooled by LN2 to -100 °C, were investigated and compared to those of dry and wet cutting.The machined surface integrity was characterized in terms of microstructure, hardness, residual stresses and surface roughness. Electrochemical studies, making use of potentiodynamic and cyclic polarization tests, were carried out to evaluate the corrosion resistance of the machined surfaces.It was found that the AISI 316L microstructure near the machined surface was significantly affected by the machining cooling strategies The effectiveness of using low-temperature coolants in machining of stainless steels for the manufacture of reusable medical devices was therefore demonstrated.

Enhancement of corrosion resistance to sterilization stages of a biomedical grade AISI 316L stainless steel by means of low-temperature machining

Austenitic stainless steels are currently used for the manufacture of reusable medical instruments, thanks to their combination of elevated strength, corrosion resistance, biocompatibility and low cost. However, during their service life, they are subjected to repeated sterilization cycles, which lead to the loosening of the surface oxide stability and, as a consequence, the decrease of their durability.In the present study, the in-service corrosion behaviour of the AISI 316L stainless steel was investigated after being machined using two low-temperature coolants, namely Liquid Nitrogen (LN2) and gaseous Nitrogen (N2) cooled by LN2 to -100°C, as well as using a conventional cutting fluid.Results showed that the AISI 316L microstructure near the machined surface was significantly affected by the machining cooling strategies with the generation of a hardened and more compressed layer when low-temperature coolants were used. Such surface integrity enhancements contributed to improve both the general and localized corrosion resistance to sterilization stages. From this basis, machining using low temperature coolants can be considered a suitable technique to manufacture medical devices of increased durability.

Robotic-assisted versus laparoscopic unilateral inguinal hernia repair: a comprehensive cost analysis.

Cost-effectiveness of robotic-assisted surgery is still debatable. Robotic-assisted inguinal hernia repair has no clear clinical benefit over laparoscopic repair. We performed a comprehensive cost-analysis comparison between the two approaches for evaluation of their cost-effectiveness in a large healthcare system in the Western United States. Health records in 32 hospitals were queried for procedural costs of inguinal hernia repairs between January 2015 and March 2017. Elective robotic-assisted or laparoscopic unilateral inguinal hernia repairs were included. Cost calculations were done using a utilization-based costing model. Total cost included: fixed cost, which comprises medical device and personnel costs, and variable cost, which comprises disposables and reusable instruments costs. Other outcome measures were length of stay (LOS), conversion to open, and operative times. Statistics were done using t test for continuous variables and χ2 test for categorical variables. A p-value < 0.05 was considered significant. A total of 2405 cases, 734 robotic-assisted (633 Primary: 101 recurrent) and 1671 laparoscopic (1471 Primary: 200 recurrent), were included. The average total cost was significantly higher (p < 0.001) in the robotic-assisted group ($5517) compared to the laparoscopic group ($3269). However, the average laparoscopic variable cost ($1105) was significantly higher (p < 0.001) than the robotic-assisted cost ($933). Whereas there was no significant difference between the two groups for LOS and conversion to open, average operative times were significantly higher in the robotic-assisted group (p < 0.001). Subgroup analysis for primary and recurrent inguinal hernias matched the overall results. Robotic-assisted inguinal hernia repair has a significantly higher cost and significantly longer operative times, compared to the laparoscopic approach. The study has shown that only fixed cost contributes to the cost difference between the two approaches. Medical device cost plus the longer operative times are the main factors driving the cost difference. Laparoscopic unilateral inguinal hernia repair is more cost-effective compared to a robotic-assisted approach.

Regional cost analysis for laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is the most common procedure performed by general surgeons in the United States, with approximately 600,000 procedures performed annually. As the cost of care rises, there is increasing emphasis on utilization and quality. Our objective was to evaluate the cost of laparoscopic cholecystectomy in our health system and to compare the operative times and outcomes at high- and low-cost centers. We evaluated all laparoscopic cholecystectomies performed in our system over a 1-year period. The operating room supply costs and procedure durations were obtained for each of the hospitals. The American College of Surgeons National Surgical Quality Improvement Program outcomes and demographics were compared to the costs for each hospital. During the study period, 7601 laparoscopic cholecystectomies were performed at 20 hospitals (170-759/hospital) by 227 surgeons. The average cost per case ranged from $296 at the lowest cost center to $658 at the highest cost center. The average operative time varied between sites from 46 to 95min. There was no association between cost and operative time or case volume. There was a slight trend toward increased cost with higher number of emergency procedures, but this was not well correlated (R2 = 0.03). The patient demographics and comorbidities were similar between sites. There were no significant differences in postoperative complications between high- and low-cost centers. The items with the greatest increase in cost were disposable trocars, disposable hook cautery, disposable endoscissors, and disposable clip appliers. We estimate that a savings of over $300/case is possible by using reusable instruments, which would result in an annual savings of $1.3million for our health system, and $285million nationwide. Performing laparoscopic cholecystectomy with reusable instruments can significantly decrease costs and does not increase operative time or postoperative complications.