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Eremiev A, London D, Ber R, Kurland DB, Sheerin K, Dennett H, Pacione D, Laufer I. Digital Preoperative Huddle Platform Use Leads to Decreased Surgical Cost. Neurosurgery 2024:00006123-990000000-01192. [PMID: 38842337 DOI: 10.1227/neu.0000000000002994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/25/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Communication has a well-established effect on improving outcomes. The current study evaluated the effect of multidisciplinary preoperative team communication using a digital huddle software platform on operating room costs. METHODS A digital huddle software platform was implemented in March 2022 for neurosurgical procedures performed at a single tertiary care center. Surgeons were encouraged, but not required, to participate. General linear models were used to test the association between participation and the difference in supply-related cost and case length, using intergroup comparison and historical controls. RESULTS A total of 29626 cases (performed by 97 surgeons), conducted between March 2021 and June 2023, were included in our analysis. Cases from participating neurosurgeons (12 surgeons, 4064 cases) were compared with cases from nonparticipating neurosurgeons (6 surgeons, 2452 cases), non-neurosurgery cases carried out by the same operating room staff (20 orthopedic spine surgeons, 6073 cases), and non-neurosurgery cases performed in a different operating room unit (59 surgeons, 21 996 cases). In aggregate, operating room (OR) costs increased by 7.3% (95% CI: 0.9-14.1, P = .025) in the postintervention period. In the same period, participation in the digital huddle platform was associated with an OR utilization and supply-related cost decrease of 16.3% (95% CI: 8.3%-23.6%, P < .001). Among neurosurgeons specifically, participation was associated with a supply-related cost decrease of 17.5% (95% CI: 6.0%-27.5%, P = .0037). There was no change in case length (median case length 171 minutes, change: +2.7% increase, 95% CI:-2.2%-7.9%, P = .28). CONCLUSION The implementation of a digital huddle software platform resulted in an OR utilization and supply cost decrease among participants during a period when the overall nonparticipating control cohort experienced an increase in cost.
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Affiliation(s)
- Alexander Eremiev
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA
| | - Dennis London
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA
| | - Roee Ber
- Department of Neurosurgery, Northwell Health, New Hyde Park, New York, USA
| | - David B Kurland
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA
| | - Kathleen Sheerin
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA
| | - Haleigh Dennett
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA
| | - Donato Pacione
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA
| | - Ilya Laufer
- Department of Neurosurgery, NYU Langone Medical Center, New York, New York, USA
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2
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Restaino S, Tius V, Arcieri M, Biasioli A, Pellecchia G, Driul L, Vizzielli G. "Water or not water: That is the question." Analysis of costs and consumption of the operating theaters in a greener perspective. Int J Gynaecol Obstet 2024; 165:1167-1171. [PMID: 38205879 DOI: 10.1002/ijgo.15325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/30/2023] [Accepted: 12/11/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE To compare the amounts of water and plastic used in surgical hand washing with medicated soaps and with alcohol-based products and to compare costs and consumption in a year, based on scheduled surgical activity. METHOD This retrospective study was carried out at Udine's Gynecology Operating Block from October to November 2022. We estimated the average amount of water with a graduated cylinder and the total cost of water usage based on euros/m3 indicated by the supplier; for each antiseptic agent we collected the data relevant to wash time, amount of water and product used per scrub, number of handscrubs made with every 500 mL bottle and cost of a single bottle. We put data into two hypothetical contexts, namely WHO guidelines and manufacturers' recommendations. Data were subjected to statistical analysis. RESULTS The daily amount of water using povidone-iodine, chlorhexidine-gluconate and alcohol-based antiseptic agents was 187.6, 140.7 and 0 L/day (P value = 0.001), respectively; A total of 69 000 L/year of water would be saved if alcohol-based products were routinely used. A single unit of an alcohol-based product allows three times as many handscrubs as any other product (P value = 0.001) with consequent reduction in plastic packaging. CONCLUSION Despite the cost saving being negligible, choosing alcohol-based handrub over medicated soap handrub - on equal antiseptic efficacy grounds - could lead to a significant saving of water and plastic, thus making our operating theaters more environmentally friendly.
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Affiliation(s)
- Stefano Restaino
- Clinic of Obstetrics and Gynecology, "S. Maria della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Veronica Tius
- Medical Area Department (DAME), University of Udine, Udine, Italy
| | - Martina Arcieri
- Clinic of Obstetrics and Gynecology, "S. Maria della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
- Department of Biomedical, Dental, Morphological and Functional Imaging Science, University of Messina, Messina, Italy
| | - Anna Biasioli
- Clinic of Obstetrics and Gynecology, "S. Maria della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | | | - Lorenza Driul
- Clinic of Obstetrics and Gynecology, "S. Maria della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
- Medical Area Department (DAME), University of Udine, Udine, Italy
| | - Giuseppe Vizzielli
- Clinic of Obstetrics and Gynecology, "S. Maria della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
- Medical Area Department (DAME), University of Udine, Udine, Italy
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Trieu E, Ramirez-Caban LC, Shockley ME. Review of sustainable practices for the gynecology operating room. Curr Opin Obstet Gynecol 2024:00001703-990000000-00137. [PMID: 38837721 DOI: 10.1097/gco.0000000000000965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW Climate change has immediate impacts on women's health. Hospitals and operating rooms are large contributors to greenhouse gas (GHG) emissions and waste. This article will review current green initiatives designed to minimize environmental impact in the operating room and highlight areas for future improvement. RECENT FINDINGS From a materials perspective, reusable goods result in less GHG emissions while being just as efficacious, well tolerated, and easy to use. Materials should be opened judiciously, only as necessary. Processing regulated medical waste produces greater GHG emissions, so waste should be properly sorted, and items which are not biohazard waste should be processed separately. Choosing appropriate anesthesia and utilizing an 'off' setting, in which operating rooms are shut down when not in use, can also drastically decrease the environmental impact of surgery. Further research is needed to determine effective implementation in hospitals. SUMMARY This article summarizes current attempts to make operating rooms more sustainable. Many practices result in a decreased carbon footprint and cost savings without adversely affecting patient outcomes. Gynecologic surgeons and the hospitals in which they practice need to focus on implementing these changes in a timely fashion.
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Affiliation(s)
- Elissa Trieu
- Division of Gynecologic Specialties, Department of Obstetrics and Gynecology, Emory University, Atlanta, Georgia, USA
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Rouvière N, Pitard M, Boutry E, Prudhomme M, Bertrand M, Leguelinel-Blache G, Chasseigne V. How a hospital pharmacist can contribute to a more sustainable operating theater. J Visc Surg 2024; 161:37-45. [PMID: 38092591 DOI: 10.1016/j.jviscsurg.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Healthcare sectors, particularly operating theaters, are major consumers of resources. Given today's climate-related issues, its seems vital that the different healthcare professionals in operating areas become aware of their roles. This is pronouncedly the case for hospital pharmacists, who fulfill cross-sectional functions in the proper use and management of healthcare products and sterile medical devices. The objective of this review of the literature is to identify the actions a hospital pharmacist can take to impel evolution toward ecologically responsible care in the operating theater. Seven areas in which a pharmacist can assume a leading, supporting or composite role in rendering an operating theater ecologically responsible have been highlighted: purchasing, procurement and storage, harmonization of practices, modification of practices, professional attire, waste elimination and research/teaching. The active participation of all healthcare professionals, including the hospital pharmacist, is essential to the development of a sustainable approach to healthcare.
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Affiliation(s)
- Ninon Rouvière
- Pharmacy department, Nîmes University Hospital Center, Montpellier University, place du Professeur-Robert-Debré, 30029 Nîmes cedex 9, France
| | - Maria Pitard
- Pharmacy department, Nîmes University Hospital Center, Montpellier University, place du Professeur-Robert-Debré, 30029 Nîmes cedex 9, France
| | - Etienne Boutry
- Digestive Surgery Department, Nîmes University Hospital Center, University of Montpellier, Nîmes, France
| | - Michel Prudhomme
- Digestive Surgery Department, Nîmes University Hospital Center, University of Montpellier, Nîmes, France
| | - Martin Bertrand
- Digestive Surgery Department, Nîmes University Hospital Center, University of Montpellier, Nîmes, France
| | - Géraldine Leguelinel-Blache
- Pharmacy department, Nîmes University Hospital Center, Montpellier University, place du Professeur-Robert-Debré, 30029 Nîmes cedex 9, France; Desbrest Institute of Epidemiology and Public Health, Inserm, University of Montpellier, Montpellier, France
| | - Virginie Chasseigne
- Pharmacy department, Nîmes University Hospital Center, Montpellier University, place du Professeur-Robert-Debré, 30029 Nîmes cedex 9, France; Desbrest Institute of Epidemiology and Public Health, Inserm, University of Montpellier, Montpellier, France.
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Lüdemann C, Gerken M, Hülsbeck M. The role of human capital and stress for cost awareness in the healthcare system: a survey among German hospital physicians. BMC Health Serv Res 2024; 24:310. [PMID: 38454403 PMCID: PMC10921634 DOI: 10.1186/s12913-024-10748-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 02/18/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Germany has the highest per capita health care spending among EU member states, but its hospitals face pressure to generate profits independently due to the government's withdrawal of investment cost coverage. The diagnosis related groups (DRG) payment system was implemented to address the cost issue, challenging hospital physicians to provide services within predefined prices and an economic target corridor to reduce costs. This study examines the extent of cost awareness among medical personnel in German hospitals and its influencing factors. METHODS We developed an online survey in which participants across all specialties in hospitals estimated the prices in euros of four common interventions and answered questions about their human capital and perceived stress on the workplace. As a measure of cost awareness, we used the probability of estimating the prices correctly within a reasonable margin. We employed logit logistic regression estimators to identify influencing factors in a sample of 86 participants. RESULTS The results revealed that most of the respondents were unaware of the costs of common interventions. General human capital, acquired through prior education, and job-specific human capital had no influence on cost awareness, whereas domain-specific human capital, that is, gaining economic knowledge based on self-interest, had a positive nonlinear effect on cost awareness. Furthermore, an increased stress level negatively influenced cost awareness. CONCLUSIONS This paper is the first of its kind for the German health care sector that contributes responses to the question whether health care professionals in German hospitals have cost awareness and if not, what reasons lie behind this lack of knowledge. Our findings show that the cost awareness desired by the introduction of the DRG system has yet to be achieved by medical personnel.
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Affiliation(s)
- Christoph Lüdemann
- Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58455, Witten, Germany
| | - Maike Gerken
- Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58455, Witten, Germany.
| | - Marcel Hülsbeck
- University of Applied Sciences Munich, Hohenzollernstr. 102, 80796, Munich, Germany
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6
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Reinisch-Liese A, Liese J, Ulrich F. [Sustainable waste management in general surgical operations]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:229-234. [PMID: 38114651 DOI: 10.1007/s00104-023-02012-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND AND OBJECTIVE OF THE STUDY Hospitals, especially surgical departments, are among the largest producers of waste in Germany. Data on waste management in the operating room (OR) are largely lacking. The aim of this study was to assess and discuss the possibilities of reducing waste and recovering recyclable materials in general surgery against the background of current practice. METHODOLOGY Surgical departments throughout Germany were surveyed on waste management. First, the theoretical waste separation possibilities for laparoscopic appendectomy were determined. Subsequently, a simple system for the separation of recyclables was established and practically tested in 35 operations. These were compared with 35 appendectomies without separation. RESULTS Only 25.7% of hospitals perform waste separation. Theoretically, 20.7% of waste can be recycled, in practice up to 18.9%. Paper, cardboard and plastics, especially polyethylene terephthalate (PET) and high-density polyethylene (HDPE) were separated. This leads to a significant reduction in residual waste without extending the operation time. DISCUSSION Separation of recyclables can contribute to more sustainable waste management in the OR. High-value recyclables can be recycled and the residual waste mass can be significantly reduced. This is possible without special effort and does not delay the processes in the OR. The opportunities for this have hardly been used in Germany to date.
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Affiliation(s)
- Alexander Reinisch-Liese
- Zentrum für Allgemeine, Viszerale und Onkologische Chirurgie, Klinikum Wetzlar-Braunfels, Forsthausstr. 1, 35647, Wetzlar, Deutschland.
| | - Juliane Liese
- Klinik für Allgemein-, Viszeral-, Thorax- und Transplantationschirurgie, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Frank Ulrich
- Zentrum für Allgemeine, Viszerale und Onkologische Chirurgie, Klinikum Wetzlar-Braunfels, Forsthausstr. 1, 35647, Wetzlar, Deutschland
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Laviolle B, Degon PF, Gillet-Giraud C, Thiveaud D, Lechat P, Boïko-Alaux V, Fougerou C, Jolly C, Petit A, Rémy-Jouet I, Yven R, Bouret L, Marrauld L, Vaslet MP, Delay V, Gavory AL, Olle F, Langevin J, Forteau L. How can the environmental sustainability of healthcare products be taken into account throughout their life cycle? Therapie 2024; 79:61-74. [PMID: 38102030 DOI: 10.1016/j.therap.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/20/2023] [Indexed: 12/17/2023]
Abstract
Healthcare product procurement accounts for around 50% of the French healthcare system's greenhouse gas emissions. This lesson learned from the publication of the Shift Project's work in November 2021 has been a catalyst within the healthcare system, accelerating the consideration and implementation of actions aimed at reducing the environmental impact of the healthcare system, before, during and after care. In addition to their carbon footprint, healthcare products have a wide range of environmental impacts, including on water, air and soil, throughout their entire life cycle. We have chosen to divide this life cycle into four main stages: from research and development to production, distribution and market access, use and finally end-of-life management. Analysis of the regulatory framework at each stage and of existing initiatives described in the literature or by those in the field have structured and fuelled our thinking. We found that existing regulations focus exclusively on the health risk, with little or no consideration of the environmental risk, which is in itself a health risk. Furthermore, the implementation of certain structuring actions during the first 3 stages of the life cycle would make it possible to simplify or even eliminate the major problem of waste management associated with the end-of-life of healthcare products. With this in mind, we have produced 9 recommendations to ensure that the environmental impact of healthcare products is better taken into account throughout their life cycle.
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Affiliation(s)
- Bruno Laviolle
- CHU Rennes, Univ Rennes, Inserm, UMR_S 1085 (IRSET), CIC Inserm 1414, 35000 Rennes, France.
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8
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Laviolle B, Degon PF, Gillet-Giraud C, Thiveaud D, Lechat P, Boïko-Alaux V, Fougerou C, Jolly C, Petit A, Rémy-Jouet I, Yven R, Bouret L, Marrauld L, Vaslet MP, Delay V, Gavory AL, Olle F, Langevin J, Forteau L. Comment prendre en compte la dimension éco-responsable des produits de santé tout au long de leur cycle de vie? Therapie 2024; 79:47-60. [PMID: 37993369 DOI: 10.1016/j.therap.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/20/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Bruno Laviolle
- CHU de Rennes, université de Rennes, Inserm, UMR_S 1085 (IRSET), CIC Inserm 1414, 35000 Rennes, France.
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9
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Petit HJ, Sullivan GA, Hughes IM, Pittman KL, Myers JA, Cocoma SM, Gulack BC, Shah AN. Exploring Barriers and Facilitators to Reducing the Environmental Impact of the Operating Room. J Surg Res 2023; 292:197-205. [PMID: 37639946 DOI: 10.1016/j.jss.2023.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 07/19/2023] [Accepted: 07/23/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION The operating room (OR) is a major contributor to greenhouse gas emissions both nationally and globally. Successful implementation of quality improvement initiatives requires understanding of key stakeholders' perspectives of the issues at hand. Our aim was to explore surgical, anesthesia, and OR staff member perspectives on barriers and facilitators to reducing OR waste. MATERIALS AND METHODS Identified stakeholders from a single academic medical center were interviewed to identify important barriers and facilitators to reducing surgical waste. Two team members with qualitative research experience used deductive logic guided by the Theoretical Domains Framework of behavior change to identify themes within transcripts. RESULTS Nineteen participants including surgeons (n = 3, 15.8%), surgical residents (n = 5, 26.3%), an anesthesiologist (n = 1, 5.3%), anesthesia residents (n = 2, 10.5%), nurse anesthetists (n = 2, 10.5%), nurses (n = 5, 26.3%), and a surgical technologist (n = 1, 5.3%) were interviewed. Twelve of the 14 themes within the Theoretical Domains Framework were discovered in transcripts. Barriers within these themes included lack of resources to pursue environmental sustainability in the OR and the necessity of maintaining sterility for patient safety. Facilitators included emphasizing surgeon leadership within the OR to reduce unused supplies and spreading awareness of the environmental and economic impact of surgical waste. CONCLUSIONS Interviewed stakeholders were able to identify areas where improvements around surgical waste reduction and management could be made at the institution by describing barriers and facilitators to sustainability-driven interventions. Future surgical waste reduction initiatives at this institution will be guided by these important perspectives.
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Affiliation(s)
- Hayley J Petit
- Rush Medical College, Rush University Medical Center, Chicago, Illinois
| | - Gwyneth A Sullivan
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Ian M Hughes
- Environmental Sustainability, Rush University Medical Center, Chicago, Illinois
| | - Katie L Pittman
- Environmental Sustainability, Rush University Medical Center, Chicago, Illinois
| | - Jonathan A Myers
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Sarah M Cocoma
- Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois
| | - Brian C Gulack
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Ami N Shah
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, Illinois.
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Goldfield NM, Malapati P, Chafitz T, Saravanapavan Y, Alamgir N, Gander J, Meyer MJ. Sterile surgical supply waste identification using asynchronous analysis: Pediatric surgery QI pilot. Surg Open Sci 2023; 15:32-37. [PMID: 37609369 PMCID: PMC10440549 DOI: 10.1016/j.sopen.2023.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/25/2023] [Accepted: 07/29/2023] [Indexed: 08/24/2023] Open
Abstract
Background The operating room (OR) is a major cost and revenue center for a hospital. One of the few modifiable costs in the OR is single-use, sterile surgical supplies (SUSSS). If SUSSS are opened on the scrub table and not used, then they are wasted. High-fidelity SUSSS usage data is important to strategically implement solutions to reduce waste of SUSSS in the OR. OR waste reduction may decrease health systems' carbon footprints and reduce spending. Methods A convenience sample of general pediatric surgical cases was observed in summer 2021. HIPAA-free images of the surgical scrub table were acquired every 2 s with minimal impact on pediatric OR workflow. These images were asynchronously analyzed to obtain SUSSS usage data for each case. Results Image data from three pediatric surgeons performing 41 pediatric surgeries was reviewed. The median cost of unused SUSSS was $13.10 (IQR = $2.73-$47.97) with a range of $0.07 to $489.08 wasted in a single surgery. The mean number of items wasted was 9.3 ± 6.4. The most frequently wasted items were sutures, syringes, towels, paper rulers, and specimen cups. The most expensive sources of waste were laparoscopic trocars, sutures, insufflation needles, drapes, and guidewires. Conclusions SUSSS that were discarded without being used were successfully identified through the asynchronous analysis of HIPAA-free OR scrub table image data. This may be an opportunity to identify SUSSS waste efficiently without an observer in the OR.
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Affiliation(s)
- Natalie M. Goldfield
- University of Virginia School of Medicine, 1340 Jefferson Park Ave, Charlottesville, VA, USA
| | | | - Tyler Chafitz
- Mount Sinai Health System, 1 Gustave L. Levy Pl, New York, NY, USA
| | | | - Nafisa Alamgir
- Meharry Medical College, 1005 Dr DB Todd Jr Blvd, Nashville, TN, USA
| | - Jeffrey Gander
- University of Virginia School of Medicine, 1340 Jefferson Park Ave, Charlottesville, VA, USA
| | - Matthew J. Meyer
- University of Virginia School of Medicine, 1340 Jefferson Park Ave, Charlottesville, VA, USA
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Saunders R, Caterino M, Somaiya P. A single-patient-use ECG system for cardiothoracic surgery admissions in the UK: A cost-consequence analysis. Front Public Health 2023; 11:1027977. [PMID: 37064713 PMCID: PMC10097949 DOI: 10.3389/fpubh.2023.1027977] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/13/2023] [Indexed: 04/18/2023] Open
Abstract
Background Deep sternal wound infections (DSWI) are severe complications in up to 1.36% of coronary artery bypass grafting (CABG) procedures in the United Kingdom. Each event adds between £4,000 and £11,000 in healthcare costs, owing primarily to prolonged hospitalisations. ECG devices have been shown to convey infection throughout perioperative CABG. On the other hand, single-patient ECG devices (spECG) can effectively reduce the incidence of surgical site infections (SSI), including DSWI, but no assessment of spECG impact in NHS cardiac units has been conducted. Methods To estimate the impact of spECG on NHS cardiac units, we conducted a cost-consequence analysis modeling the CABG care pathway in the United Kingdom using Simul8 software for a probabilistic, individual-patient simulation. The simulation time was 1 year, with each patient followed from admission through 30 days post-discharge. The base case simulation mirrors the cardiac unit of Bart Health NHS Trust, London. A total of 2,183 patients are generated with demographic and clinical attributes from probabilistic distributions informed by hospital-specific inputs from NHS Digital Data. The Brompton Harefield Infection Score (BHIS) is allocated to gauge the risk of SSI. Results are averaged across 50 independent and randomly seeded iterations. Results Simulation results indicate a base-case savings of £388 per patient, determined by the incidence of infections rather than the number of CABG procedures. In the base-case simulation, the mean cost of care with rECG was £13,096, whereas the mean cost with spECG was £12,708, resulting in a cost saving of £388 (2021 GBP). The simulation yielded an overall 8.6% SSI incidence rECG, whereas the incidence of SSIs with spECG was 6.9%. The model was most sensitive to changes in general ward and ICU costs, and infection incidence was a stronger predictor of potential per-patient savings than annual CABG volume. Conclusion Single-patient ECG is a sustainable and effective alternative to reusable ECG cables and lead wires in terms of patient safety and resource allocation.
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Affiliation(s)
- Rhodri Saunders
- Coreva Scientific GmbH & Co KG, Königswinter, Nordrhein-Westfalen, Germany
- *Correspondence: Rhodri Saunders
| | - Marco Caterino
- Coreva Scientific GmbH & Co KG, Königswinter, Nordrhein-Westfalen, Germany
| | - Pranav Somaiya
- Coreva Scientific GmbH & Co KG, Königswinter, Nordrhein-Westfalen, Germany
- Department of Vascular Surgery, Barts Health NHS Trust, London, United Kingdom
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Braschi C, Tung C, Chen KT. The impact of waste reduction in general surgery operating rooms. Am J Surg 2022; 224:1370-1373. [PMID: 36273939 DOI: 10.1016/j.amjsurg.2022.10.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 09/23/2022] [Accepted: 10/13/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Operating rooms are responsible for a significant burden of waste and negative environmental impact. This study aimed to reduce OR waste and improve both environmental impact and hospital cost savings. METHODS The unused items in two standard single-use surgical packs were tracked for general surgery cases. A new pack was created excluding the most frequently unused items. The feasibility of the new pack was then tested, and a projected cost savings analysis was performed. RESULTS A total of 35 general surgery operations were tracked using two standard packs ($89.51 or $93.68 per case, each 23.2 lbs). The new pack ($46.88 per case, 20.8 lbs) was then successfully used in nine cases. The projected cost-savings of substituting the new pack was $45,719 annually with a 2437 pounds annual waste reduction. CONCLUSIONS Simple and feasible adjustments to standard single-use surgical packs can have a significant impact on waste reduction and cost-savings.
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Affiliation(s)
- Caitlyn Braschi
- Division of Surgical Oncology, Department of Surgery, Harbor-UCLA Medical Center, USA.
| | - Christine Tung
- Division of Surgical Oncology, Department of Surgery, Harbor-UCLA Medical Center, USA
| | - Kathryn T Chen
- Division of Surgical Oncology, Department of Surgery, Harbor-UCLA Medical Center, USA
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Martinel V, Nourissat G, Barth J, Zipoli B, Bonnevialle N. The Hybridge Technique: A Combined Technique of Suture Bridge and Tension Band for an Arthroscopic Eco-Responsible Rotator Cuff Repair. Arthrosc Tech 2022; 11:e2337-e2345. [PMID: 36632402 PMCID: PMC9827004 DOI: 10.1016/j.eats.2022.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/22/2022] [Indexed: 11/19/2022] Open
Abstract
Arthroscopic rotator cuff repair is mainly based on 2 proven biomechanical concepts: suture bridge and tension band. This Technical Note describes the use of a combination of these 2 techniques to repair extensive lesions with only 3 anchors. Besides being less expensive, the use of a limited number of anchors is part of a global medicoeconomic and eco-responsible approach to our surgical activities.
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Affiliation(s)
- Vincent Martinel
- Groupe Orthopédie Ormeau Pyrénées, ELSAN - Polyclinique de l’Ormeau, Tarbes, France,Address correspondence to Vincent Martinel, M.D., Groupe Orthopédie Ormeau Pyrénées, ELSAN - Polyclinique de l’Ormeau, 28 Bvd du 8 Mai 1945, 65000 Tarbes, France.
| | | | - Johannes Barth
- Département de chirurgie orthopédique, Centre ostéoarticulaire des cèdres, Parc Sud Galaxie, Echirolles, Grenoble, France
| | - Bruno Zipoli
- Service orthopédie et traumatologie, centre hospitalier de Dax, Dax, France
| | - Nicolas Bonnevialle
- Département d’orthopédie traumatologie CHU de Toulouse, place du docteur Baylac, Hôpital Riquet, Toulouse, France,Green Shoulder Circle, Lourdes, France, France
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Bette B, Kim SC, Kruse P, Coburn M. Sustainable work in anaesthesiology and intensive care medicine. Anasthesiol Intensivmed Notfallmed Schmerzther 2022; 57:647-654. [DOI: 10.1055/a-1683-2164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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15
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Papadopoulou A, Kumar NS, Vanhoestenberghe A, Francis NK. Environmental sustainability in robotic and laparoscopic surgery: systematic review. Br J Surg 2022; 109:921-932. [PMID: 35726503 DOI: 10.1093/bjs/znac191] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/11/2022] [Accepted: 05/09/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Minimally invasive surgical (MIS) techniques are considered the gold standard of surgical interventions, but they have a high environmental cost. With global temperatures rising and unmet surgical needs persisting, this review investigates the carbon and material footprint of MIS and summarizes strategies to make MIS greener. METHODS The MEDLINE, Embase, and Web of Science databases were interrogated between 1974 and July 2021. The search strategy encompassed surgical setting, waste, carbon footprint, environmental sustainability, and MIS. Two investigators independently performed abstract/full-text reviews. An analysis of disability-adjusted life years (DALYs) averted per ton of carbon dioxide equivalents (CO2e) or waste produced was generated. RESULTS From the 2456 abstracts identified, 16 studies were selected reporting on 5203 MIS procedures. Greenhouse gas (GHG) emissions ranged from 6 kg to 814 kg CO2e per case. Carbon footprint hotspots included production of disposables and anaesthetics. The material footprint of MIS ranged from 0.25 kg to 14.3 kg per case. Waste-reduction strategies included repackaging disposables, limiting open and unused instruments, and educational interventions. Robotic procedures result in 43.5 per cent higher GHG emissions, 24 per cent higher waste production, fewer DALYs averted per ton of CO2, and less waste than laparoscopic alternatives. CONCLUSION The increased environmental impact of robotic surgery may not sufficiently offset the clinical benefit. Utilizing alternative surgical approaches, reusable equipment, repackaging, surgeon preference cards, and increasing staff awareness on open and unused equipment and desflurane avoidance can reduce GHG emissions and waste.
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Affiliation(s)
| | - Niraj S Kumar
- University College London Medical School, University College London, London, UK
| | - Anne Vanhoestenberghe
- UCL Institute of Orthopaedics and Musculoskeletal Sciences Royal National Orthopaedic Hospital (RNOH), Brockley Hill, UK
| | - Nader K Francis
- Division of Surgery and Interventional Science, University College London, London, UK.,The Griffin Institute, Northwick Park and St Mark's Hospital, Harrow, UK
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Poirrier AL, Mertens D, Herman D, Camby S, Scholtes B, Scholtes F. Weight and cost of unused operating room supplies. Am J Surg 2022; 224:1174-1175. [DOI: 10.1016/j.amjsurg.2022.05.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 11/01/2022]
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Rouvière N, Chkair S, Auger F, Alovisetti C, Bernard MJ, Cuvillon P, Kinowski JM, Leguelinel-Blache G, Chasseigne V. Ecoresponsible actions in operating rooms: A health ecological and economic evaluation. Int J Surg 2022; 101:106637. [PMID: 35487421 DOI: 10.1016/j.ijsu.2022.106637] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/26/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND In the current context of climate change, actions must be taken to improve the hospital's ecological footprint, particularly in the operating room, which is a major consumer of medical devices. METHODS This prospective pilot study assessed the ecological and economic impacts of sustainable actions targeting medical devices designed by a multidisciplinary working group and implemented in the 24 operating rooms of a University Hospital over one year. The ecological analysis was based on the life cycle assessment method and categorized in seven impacts. The economic impact was assessed by a micro-costing analysis and divided in four main expense items: human and material resources, logistics, and waste management. RESULTS In total, 13 actions were implemented with the aim of reducing waste volume, improving waste sorting, and increasing eco-responsible purchases. In one year, these 13 actions allowed avoiding the emission of 203 tons eq CO2. The environmental and human toxicity benefits were 707.8 and 156.2 tons of 1.4 dichlorobenzene, respectively. Concerning non-renewable resources, these actions avoided the extraction of 9 tons of oil (petroleum) and 610 kg of copper per year. These actions led to a land occupation reduction of 1071.3 m2year and to water saving of 552 m3. From the economic side, the implementation of these actions brought a gain of €3747.9 for the first year and of €5188.2 for the following years. CONCLUSION The integration of sustainable measures in operating rooms leads to important ecological benefits and also generating savings. This more eco-responsible approach should be considered in all healthcare establishments that generate a significant annual volume of waste.
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Affiliation(s)
- N Rouvière
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France
| | - S Chkair
- UA11 Institute Desbrest of Epidemiology and Public Health, INSERM, Univ Montpellier, Montpellier, France; Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, Nimes University Hospital, University of Montpellier, Nimes, France
| | - F Auger
- Primum Non Nocere Agency, Beziers, France
| | - C Alovisetti
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, University Hospital of Nîmes, Nîmes, France
| | - M J Bernard
- Department of General Surgery, University Hospital of Nîmes, Nîmes, France
| | - P Cuvillon
- Department of Anesthesiology and Critical Care, University Hospital of Nîmes, Nîmes, France
| | - J-M Kinowski
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France; UA11 Institute Desbrest of Epidemiology and Public Health, INSERM, Univ Montpellier, Montpellier, France
| | - G Leguelinel-Blache
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France; UA11 Institute Desbrest of Epidemiology and Public Health, INSERM, Univ Montpellier, Montpellier, France
| | - V Chasseigne
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France; UA11 Institute Desbrest of Epidemiology and Public Health, INSERM, Univ Montpellier, Montpellier, France.
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18
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Baxter NB, Yoon AP, Chung KC. Variability in the Use of Disposable Surgical Supplies: A Surgeon Survey and Life Cycle Analysis. J Hand Surg Am 2021; 46:1071-1078. [PMID: 34275683 DOI: 10.1016/j.jhsa.2021.05.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/02/2021] [Accepted: 05/19/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE A substantial amount of waste is generated during surgery, yet few studies have investigated this problem. Therefore, we conducted a multicenter survey to investigate how the variation in the use of disposable supplies contributes to the environmental and financial burdens of health care. METHODS We created a questionnaire to identify differences in supply use and practice characteristics among hand surgeons who participated in the Wrist and Radius Injury Surgical Trial. We determined the average cumulative cost of 10 key surgical items based on the responses. Subsequently, we estimated the kilograms of carbon dioxide emitted during the life cycle of supplies, from raw material extraction to production and disposal, using economic input-output life cycle analysis. RESULTS Thirty-five surgeons from 19 institutions responded to the survey (65% response rate). Based on the difference in costs between surgeons who used the fewest and the most supplies, we determined that expenditures and carbon dioxide emissions could decrease by $22.47 and 10.9 kg per procedure, respectively, with leaner use of 10 key items. Furthermore, assuming that surgeon variation in supply use is present in other surgical subspecialties, we estimated that $2.4 billion in savings and an 800.6 thousand metric ton reduction in carbon emissions could be achieved if all US surgeons reduced their supply use by this amount. CONCLUSIONS This study revealed considerable variations in the use of disposable supplies among hand surgeons, highlighting the need for evidence-based tools, policies, and education campaigns to reduce hospital waste across health care systems. CLINICAL RELEVANCE Optimal use of disposable supplies is necessary to reduce the cost and environmental burden of hand surgery care.
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Affiliation(s)
- Natalie B Baxter
- Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, MI
| | - Alfred P Yoon
- Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, MI
| | - Kevin C Chung
- Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, MI.
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Abstract
BACKGROUND The climate crisis is the most serious threat to global health in the twenty-first century. In western countries 5-10% of all greenhouse gas emissions originate from the healthcare sector and the main contributing factors are energy-intense departments (intensive care units, operating suits and prehospital emergency services). OBJECTIVE The aim of this review is to provide background knowledge and practical ideas to achieve climate-neutral hospitals. MATERIAL AND METHODS Narrative review with information on the topics of (I) volatile anesthetics as greenhouse gases, (II) energy supply in hospitals and (III) solid waste management. RESULTS AND CONCLUSION (I) Volatile anesthetics are highly potent greenhouse gases, especially desflurane has a major global warming potential. Total intravenous anesthesia (TIVA) with propofol or regional anesthetic techniques have a much lower impact on the climate. (II) Using sustainable energy sources as well as initiating energy sparing techniques, such as light-emitting diodes (LED) and motion sensors, can reduce CO2 emissions. (III) Waste can be managed by the reduce, reuse, recycle, rethink and research concept. Doctors should actively contribute to reach the climate goals.
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Affiliation(s)
- S Koch
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum und Campus Mitte, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - S Pecher
- Klinik für Anästhesie und Intensivmedizin, Diakonie Klinikum Stuttgart, Stuttgart, Deutschland
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Cost-effective minimally invasive gynecologic surgery: emphasizing surgical efficiency. Curr Opin Obstet Gynecol 2021; 32:243-247. [PMID: 32371608 DOI: 10.1097/gco.0000000000000636] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The United States has the highest healthcare costs among developed countries. This review evaluates surgical practices and equipment choices during endoscopic hysterectomy, highlighting opportunities for the gynecologic surgeon to reduce costs and maximize surgical efficiency. RECENT FINDINGS There are opportunities to economize at every step of the endoscopic hysterectomy. When surgeons are provided education about instrumentation costs, the cost of hysterectomy has been shown to decrease. Colpotomy has been found to be the rate-limiting step in laparoscopic hysterectomy; use of a uterine manipulator likely saves time and money. When evaluating the economic impact of route of surgery, the cost differential between laparoscopic and robotic-assisted hysterectomy has decreased. Robotic-assisted hysterectomy may be more cost-effective in some cases, such as for larger uteri. From a systems-level perspective, dedicating a specific operating room team to the gynecology service can decrease operative time. SUMMARY The gynecologic surgeon is best equipped to control surgery-related costs by making choices that improve surgical efficiency and decrease operating room time. If a costlier piece of equipment leads to a more efficient case, the choice may be more cost-effective. There are multiple systems-level changes that can be implemented to decrease surgery-related costs.
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21
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Leppänen T, Kvist T, McDermott-Levy R, Kankkunen P. Nurses´ and nurse managers´ perceptions of sustainable development in perioperative work: A qualitative study. J Clin Nurs 2021; 31:1061-1072. [PMID: 34278641 DOI: 10.1111/jocn.15970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 12/07/2022]
Abstract
AIMS AND OBJECTIVES To describe how nurses and nurse managers consider sustainable development principles in their daily work, how well they recognise these principles and how these principles are considered in decision-making in perioperative work. BACKGROUND Sustainable development involves interpersonal social and cultural relations and long-term economic and ecological thinking in societal decision-making. These dimensions are well-suited for a foundation of decision-making in acute health care. No previous research has been performed on perioperative work from the sustainable development perspective. DESIGN Qualitative descriptive design was used. Data were collected from perioperative nurses (n = 20) and nurse managers (n = 6) working in five surgical departments in a Finnish university hospital. Data were analysed by content analysis. The reporting follows qualitative research checklist (COREQ). RESULTS The principles of sustainable development were poorly known among the participants. Nurse managers considered their opportunities to influence decision-making were reduced by their limited economic knowledge. Resource use, individuality, and ecological viewpoints were emphasised in the decision-making process in perioperative work. CONCLUSIONS Findings reveal that perioperative nurses and nurse managers are aware of economic and ecological sustainability, but they do not actively consider it as part of their work. Social and cultural sustainability must be developed further in decision-making in perioperative work. RELEVANCE TO CLINICAL PRACTICE Perioperative nurses and nurse managers consider that it is important to develop the principles of sustainable development in perioperative work. This research indicates that economic understanding is not guiding decision-making, and there is a lack of knowledge about the benefits of ecological procedures. Social and cultural sustainability are not connected in perioperative work, although there is collaboration between the surgical team and the patient is essential. This study helps to organise operating room management effectively and diversely.
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Affiliation(s)
- Taava Leppänen
- Department of Nursing Sciences, University of Eastern Finland, Kuopio, Finland
| | - Tarja Kvist
- Department of Nursing Sciences, University of Eastern Finland, Kuopio, Finland
| | - Ruth McDermott-Levy
- Villanova University M Louise Fitzpatrick College of Nursing, M. Louise Fitzpatrick College of Nursing, Villanova, PA, USA
| | - Päivi Kankkunen
- Department of Nursing Sciences, University of Eastern Finland, Kuopio, Finland
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Zimmermann GDS, Siqueira LD, Bohomol E. Lean Six Sigma methodology application in health care settings: an integrative review. Rev Bras Enferm 2021; 73:e20190861. [PMID: 33338158 DOI: 10.1590/0034-7167-2019-0861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/01/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to analyze the scientific production on the results of Lean Six Sigma methodology in health care institutions. METHODS an integrative literature review, with the following question: what are the results in health institutions using Lean Six Sigma and Six Sigma methodology? The search was carried out at MEDLINE, LILACS, BDENF, CINAHL, Web of Science, and Scopus, with no time frame. RESULTS thirty-four articles were included, published between 2005 and 2019, of which 52.9% came from the United States of America. The most commonly found improvements were in hospital institutions and from the perspective of customers and internal processes. CONCLUSION using Lean Six Sigma methodology proved to be effective in the different health care settings, evidencing a gap in its application regarding people engagement and training.
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Affiliation(s)
| | - Luciola Demery Siqueira
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem. São Paulo, São Paulo, Brazil
| | - Elena Bohomol
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem. São Paulo, São Paulo, Brazil
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23
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Surgical team familiarity and waste generation in the operating room. Am J Surg 2021; 222:694-699. [PMID: 34024630 DOI: 10.1016/j.amjsurg.2021.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/07/2021] [Accepted: 05/13/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Wastage of surgical supplies results from inappropriate anticipation of surgical needs in the operating room and contributes to avoidable healthcare costs. METHODS A retrospective, cross-sectional analysis of 28,768 elective cases at the University of Chicago Medical Center from 2016 through 2018 was conducted. Attending surgeon-scrub nurse and surgeon-circulating nurse familiarity scores were calculated. Odds of surgical waste generation based on surgeon-scrub nurse and surgeon-circulating nurse familiarity were estimated through multivariate logistic regression modeling. RESULTS Teams in the third and fourth quartiles of surgeon-scrub familiarity were significantly associated with reduced odds of waste (odds ratios 0.80 [p = 0.003] and 0.83 [p = 0.030], respectively). There was no significant reduction of odds of waste generation as surgeon-circulator familiarity increased. CONCLUSIONS Greater surgeon-scrub familiarity was associated with lower risk of waste generation. Cost savings may be realized through supporting staffing schedules that promote consistency of surgeon-scrub teams.
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Pouget AM, Civade E, Cestac P, Rouzaud-Laborde C. From hospitalisation to primary care: integrative model of clinical pharmacy with patients implanted with a PICC line-research protocol for a prospective before-after study. BMJ Open 2021; 11:e039490. [PMID: 33827827 PMCID: PMC8031034 DOI: 10.1136/bmjopen-2020-039490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Clinical pharmacy improves patient safety and secures drug management using information, education and good clinical practices. However, medical device management is still unexplored, and proof of effectiveness is needed. A PICC line (peripherally inserted central catheter) is a medical device for infusion. It accesses the central venous system after being implanted in a peripheral vein. However, complications after implantation often interfere with smooth execution of the treatment. We hypothesise that clinical pharmacy for medical devices could be as effective as clinical pharmacy for medications. The main objective is to assess the effectiveness of clinical pharmacy activities on the complication rate after PICC line implantation. METHODS AND ANALYSIS This is a before-after prospective study. The study will begin with an observational period without clinical pharmacy activities, followed by an interventional period where pharmacists will intervene on drug and medical device management and provide personalised follow-up and advice. Sixty-nine adult patients will be recruited in each 6-month period from all traditional care units. The main inclusion criteria will be the implantation of a PICC line. The primary outcome is the decrease in the number of complications per patient and per month. Secondary outcomes are the consultation and hospital readmission rates, the acceptance rate of pharmaceutical interventions, the patients' quality of life, the direct hospital induced or avoided costs and the participants' satisfaction. Data will be collected using case report forms during hospitalisation and telephone follow-up after discharge. The analysis will compare these criteria during the two periods. ETHICS AND DISSEMINATION The study has received the approval of our Ethics Committee (Clermont-Ferrand Southeast VI, France, number AU1586). Results will be made available to the patients or their caregivers, the sponsor and other researchers when asked, as described in the consent form. TRIAL REGISTRATION NUMBER NCT04359056.
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Affiliation(s)
- Alix Marie Pouget
- Department of Pharmacy, University Hospital Centre Toulouse, Toulouse, Occitanie, France
- INSERM unit 1048, I2MC, Toulouse, Occitanie, France
| | - Elodie Civade
- Department of Pharmacy, University Hospital Centre Toulouse, Toulouse, Occitanie, France
| | - Philippe Cestac
- Department of Pharmacy, University Hospital Centre Toulouse, Toulouse, Occitanie, France
| | - Charlotte Rouzaud-Laborde
- Department of Pharmacy, University Hospital Centre Toulouse, Toulouse, Occitanie, France
- INSERM unit 1048, I2MC, Toulouse, Occitanie, France
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Heiman AJ, Camargo L, Bhat D, Desai V, Patel A, Ricci JA. Curtailing Unnecessary Waste Among Operating Room Personnel: Evaluating the Cost Awareness of Commonly Used Surgical Items. Am Surg 2021; 88:1263-1268. [PMID: 33596104 DOI: 10.1177/0003134821995079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Operating rooms (ORs) generate 70% of hospital waste, leading to increased costs for the hospital, patient, and the environment. The lack of cost awareness among physicians has been well documented; however, there is little information on anesthesiologists or ancillary OR staff. This study aimed to evaluate the cost awareness of commonly used items at an academic medical center among OR personnel. METHODS Anonymous surveys were distributed to OR personnel (nurses, surgical technicians (STs), nurse anesthetists, anesthesiologists, surgeons, and residents), asking for the estimated costs of ten commonly used items. These costs were then compared against actual costs to evaluate the accuracy of participants' estimates. Responders were clustered by job, highest level of education, and years of experience for comparison. RESULTS 167 surveys were collected, and overall only 16.4% of estimates were accurate within 50% of actual price. No significant differences in accuracy between groups were identified overall (P = .2), but both surgical and anesthesia attendings had significantly higher rates of correct responses than their respective residents. No difference was seen in accuracy when all attendings (surgeons and anesthesiologists) were compared with either nurses or STs. Linear regression demonstrated no correlation between number of years at current position or years at institution and number of correct responses (R2 = .0025 and R2 = .005, respectively). DISCUSSION Addressing the knowledge deficit around item costs via global education of all OR personnel (surgeons, anesthesia providers, and ancillary staff) could be a viable pathway to reduce waste, and thus cost, for our healthcare system.
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Affiliation(s)
- Adee J Heiman
- Division of Plastic Surgery, 138207Albany Medical Center, Albany, NY, USA
| | - Lauren Camargo
- Division of Plastic Surgery, 138207Albany Medical Center, Albany, NY, USA
| | - Deepa Bhat
- Division of Plastic Surgery, 138207Albany Medical Center, Albany, NY, USA
| | - Vilok Desai
- Division of Plastic Surgery, 138207Albany Medical Center, Albany, NY, USA
| | - Ashit Patel
- Division of Plastic Surgery, 138207Albany Medical Center, Albany, NY, USA
| | - Joseph A Ricci
- Division of Plastic and Reconstructive Surgery, Department of Surgery, 2013Montefiore Medical Center, Bronx, NY, USA
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Ikuma L, Nahmens I, Ahmad A, Gudipudi Y, Dasa V. Resource evaluation framework for total knee arthroplasty. Int J Health Care Qual Assur 2020; 33:189-198. [PMID: 32233354 DOI: 10.1108/ijhcqa-04-2019-0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This article describes a framework for evaluating efficiency of OR procedures incorporating time measurement, personnel activity, and resource utilization using traditional industrial engineering tools of time study and work sampling. METHODS The framework measures time using time studies of OR procedures and work sampling of personnel activities, ultimately classified as value-added or non-value-added. Statistical methods ensure that the collected samples meet adequate levels of confidence and accuracy. Resource utilization is captured through documentation of instrument trays used, defects in instruments, and trash weight and classification at the conclusion of surgeries. FINDINGS A case study comprising 12 observations of total knee arthroplasty surgeries illustrates the use of the framework. The framework allows researchers to compare time, personnel, and resource utilization simultaneously within the OR setting. PRACTICAL IMPLICATIONS The framework provides a holistic evaluation of methods, instrumentation and resources, and staffing levels and allows researchers to identify areas for efficiency improvement. ORIGINALITY/VALUE The methods presented in this article are rooted in traditional industrial engineering work measurement methods but are applied to a healthcare setting in order to efficiently identify areas for improvement including time, personnel, and processes in operating rooms.
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Affiliation(s)
- Laura Ikuma
- Department of Mechanical and Industrial Engineering, Louisiana State University and A&M College, Baton Rouge, Louisiana, USA
| | - Isabelina Nahmens
- Department of Mechanical and Industrial Engineering, Louisiana State University and A&M College, Baton Rouge, Louisiana, USA
| | - Amani Ahmad
- Department of Mechanical and Industrial Engineering, Louisiana State University and A&M College, Baton Rouge, Louisiana, USA
| | - Yasaswi Gudipudi
- Department of Mechanical and Industrial Engineering, Louisiana State University and A&M College, Baton Rouge, Louisiana, USA
| | - Vinod Dasa
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
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27
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Considerations for environmentally sustainable head and neck surgical oncology practice. Am J Otolaryngol 2020; 41:102719. [PMID: 32947153 DOI: 10.1016/j.amjoto.2020.102719] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/07/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the potential role of head and neck oncologic surgeons in environmental protection, sustainability of health-care systems and avoidance of procedures contributing to climate change in the future. REVIEW METHODS This literature review searched for relevant literature about the relevance of waste in surgical head and neck oncology practice and the innovative alternatives to decrease its effect on environment. CONCLUSIONS Head and neck oncologic surgeons have a role in environmental protection, sustainability of health-care systems and avoidance of procedures contributing to climate change in the future. However, there exist only limited data on waste management and other procedures in surgical oncology to promote these practices. IMPLICATIONS FOR PRACTICE By increasing awareness of the corresponding issues of waste production within the healthcare environment, head and neck surgeons can have a pioneering role in considering how to reduce, recycle and reuse in a more efficient manner. As research in this field accumulates, healthcare providers can engage both managers and clinicians in this process. It remains imperative to provide these professionals opportunities for their work force to rethink current practices in a manner that prioritizes environmentally sustainable head and neck surgical practices.
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Chasseigne V, Bouvet S, Chkair S, Buisson M, Richard M, de Tayrac R, Bertrand MM, Castelli C, Kinowski JM, Leguelinel-Blache G. Health economic evaluation of a clinical pharmacist's intervention on the appropriate use of devices and cost savings: A pilot study. Int J Surg 2020; 82:143-148. [PMID: 32871270 DOI: 10.1016/j.ijsu.2020.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Good management of disposable and reusable supplies may improve surgical efficiency in the operating room (OR) and also corresponds to the best eco-responsible approach. The purpose of this study was to assess the impact of a clinical pharmacist's intervention in the OR on the non-compliant use of medical devices. We also assessed the economic impact of the pharmaceutical intervention. MATERIALS AND METHODS We conducted a monocentric prospective study in the OR of a University hospital over one year. Three surgical specialties: urologic, digestive and gynecologic were audited after a preparatory phase to optimize usage of medical devices used for surgeries. The supply costs concerning the three specialties were compared before and after the pharmacist intervention. RESULTS One hundred and fifty surgical procedures were audited in digestive (33.3%, n = 50), gynecologic (32%, n = 48) and urologic (34.7%, n = 52) surgeries. With the pharmacist in OR, 51 procedures (34% CI95%[26.4%; 41.6%]) with a non-compliance concerning at least one medical device were found compared to the 50% rate without the pharmacist reported previously (P < .0001). Eighteen percent of surgical procedures had at least one circulator retrieval for the reason "incomplete case cart despite device listed on the case cart list" versus 29.1% before pharmacist intervention (P = .0028). A €33 014 saving associated with the presence of the pharmacist in OR was observed. CONCLUSIONS This prospective interventional study showed that the intervention of a pharmacist specialized in the medical device field could significantly reduce non-compliances in medical device use and reduce costs in OR.
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Affiliation(s)
- Virginie Chasseigne
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France; UPRES EA2415, Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, Clinical Research University Institute, University of Montpellier, Montpellier, France.
| | - Sophie Bouvet
- UPRES EA2415, Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, Clinical Research University Institute, University of Montpellier, Montpellier, France; Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, Nimes University Hospital, University of Montpellier, Nimes, France
| | - Sihame Chkair
- UPRES EA2415, Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, Clinical Research University Institute, University of Montpellier, Montpellier, France; Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, Nimes University Hospital, University of Montpellier, Nimes, France
| | - Marlène Buisson
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France
| | - Marie Richard
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France
| | - Renaud de Tayrac
- Department of Obstetrics and Gynecology, Nimes University Hospital, University of Montpellier, Nimes, France
| | - Martin Marie Bertrand
- Department of Visceral and Digestive Surgery, Nimes University Hospital, University of Montpellier, Nimes, France
| | - Christel Castelli
- UPRES EA2415, Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, Clinical Research University Institute, University of Montpellier, Montpellier, France; Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, Nimes University Hospital, University of Montpellier, Nimes, France
| | - Jean-Marie Kinowski
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France; UPRES EA2415, Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, Clinical Research University Institute, University of Montpellier, Montpellier, France
| | - Géraldine Leguelinel-Blache
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France; UPRES EA2415, Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, Clinical Research University Institute, University of Montpellier, Montpellier, France; Department of Law and Health Economics, Faculty of Pharmacy, University of Montpellier, Montpellier, France
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Abstract
Nurses have the capacity and opportunity to alter their organization's environmental footprint. This article addresses how they can strengthen efficiency and environmental sustainability initiatives in their facilities by engaging in, monitoring, and supporting environmentally friendly clinical practices and programs at the point of care. Included are practical tips and examples of projects in which nurses identified sources of waste-the relaundering of unused linens; disposal of unused products; and improper sorting of pharmaceutical waste, recycling, and regulated medical waste-and realized significant cost savings as well as improved efficiency and environmental sustainability.
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Sorber R, Dougherty G, Stobierski D, Kang C, Hicks CW, Lum YW. Cost Awareness of Common Supplies Is Severely Impaired Among All Members of the Surgical Team. J Surg Res 2020; 251:281-286. [PMID: 32199336 DOI: 10.1016/j.jss.2020.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/07/2020] [Accepted: 02/16/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Increased health care spending concerns have generated interest in reducing operating room (OR) costs, but the cost awareness of the surgical team selecting intraoperative supplies remains unclear. This work characterizes knowledge of supply cost among surgeons and OR staff in a large academic hospital and seeks to examine the role of experience and training with regards to cost insight. METHODS This work is a cross-sectional study of surgeons, trainees, nurses, and surgical technicians (n = 372) across all surgical specialties at a large academic hospital. Participants completed a survey reporting frequency of use and estimated cost for 11 common surgical supplies as well as opinions on access to cost information in the OR. Cost estimation error was expressed as the ratio of estimated-to-actual cost, and groups were compared with one-way analysis of variance and chi-squared testing. Spearman correlation (ρ) was used to describe the relationship between monotonic variables. RESULTS Overestimation error was universal and ranged widely (3.80-49.79). There was no significant difference in estimation accuracy when stratified by role or years of experience. Less expensive items had higher rates of estimation error than more expensive items (P < 0.001), and a moderately strong relationship was found between decreased item cost and increased estimation error (ρ: 0.49). The overwhelming majority (91%) of respondents expressed a desire to learn more about supply pricing. CONCLUSIONS Price knowledge of common supplies is globally impaired for entire surgical team but coexists with a strong desire to augment cost awareness. Improved access to cost information has a high potential to inform surgical decision-making and decrease OR waste.
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Affiliation(s)
- Rebecca Sorber
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
| | - Geoff Dougherty
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Damian Stobierski
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Christina Kang
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Caitlin W Hicks
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Ying Wei Lum
- Department of Surgery, The Johns Hopkins Hospital, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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31
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Bayne DB, Chi TL. Assessing Cost-Effectiveness of New Technologies in Stone Management. Urol Clin North Am 2019; 46:303-313. [PMID: 30961862 DOI: 10.1016/j.ucl.2018.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Diagnosis, treatment, and follow-up are all influential in determining the overall cost to the health care system for kidney stones. New innovations in the field of nephrolithiasis have been abundant, including disposable ureteroscopes, ultrasound-guided approaches to percutaneous nephrolithotomy, and advanced laser lithotripters. Identifying cost-effective treatment strategies encourages practitioners to be thoughtful about providing value-based high-quality care and remains on important principle in the treatment of urinary stone disease.
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Affiliation(s)
- David B Bayne
- Urology, University of California San Francisco, San Francisco, CA, USA.
| | - Thomas L Chi
- Urology, University of California San Francisco, San Francisco, CA, USA
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32
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Greening the operating room. Am J Surg 2018; 216:683-688. [DOI: 10.1016/j.amjsurg.2018.07.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 05/16/2018] [Accepted: 07/14/2018] [Indexed: 11/15/2022]
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Graham CW, Komidar L, Perger L. Comparison of Polymeric Clips and Endoscopic Staplers for Laparoscopic Appendectomy. J Laparoendosc Adv Surg Tech A 2018; 29:240-242. [PMID: 30192169 DOI: 10.1089/lap.2018.0173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Appendectomy is the most common pediatric surgical procedure. To decrease the cost and environmental impact of single incision pediatric endosurgery (SIPES) appendectomy, we switched from using endoscopic staplers to polymeric clips placed with nondisposable laparoscopic appliers. The aim of this study was to compare the resulting reduction in cost and amount of waste generated per case, as well as to compare the perioperative variables and outcomes in patients in whom clips were used, with those of historical patients in whom staplers were used. MATERIALS AND METHODS Retrospective chart review of SIPES appendectomies was performed and patients in whom clips were used were compared with patients in whom staplers were used. Demographic, operative, and clinical data were collected. t-Test, Mann-Whitney test, and chi squared test were used to analyze the data as appropriate. The cost to the hospital of the clips and staplers was compared. The disposable waste generated from clips and the staplers was weighed. RESULTS A total of 246 patients were included: 111 in stapler group and 135 in clip group. There were no statistically significant differences between the groups in operative time, estimated blood loss, length of stay, and complications. There were no complications related to use of clips. In the clip group, staplers were used in 10% because base of appendix was too large, gangrenous, or perforated and could not be clipped. Use of polymeric clips was less expensive and generated less waste. CONCLUSIONS Use of polymeric clips for appendectomy is safe and effective, and results are comparable with those of stapling. Based on our data, in 90% of appendectomies, the base of appendix is amenable to clipping. This study supports use of clips over staplers to decrease cost and environmental impact.
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Affiliation(s)
- Camille W Graham
- 1 Department of Surgery, Texas A&M College of Medicine, McLane's Children's Hospital at Scott & White , Temple, Texas
| | - Luka Komidar
- 2 Department of Psychology, Faculty of Arts, University of Ljubljana , Ljubljana, Slovenia
| | - Lena Perger
- 1 Department of Surgery, Texas A&M College of Medicine, McLane's Children's Hospital at Scott & White , Temple, Texas
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A study evaluating cost awareness amongst surgeons in a health service under financial strain. Int J Surg 2018; 56:184-187. [DOI: 10.1016/j.ijsu.2018.06.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 06/04/2018] [Indexed: 11/20/2022]
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35
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Christopher E, Leow HW. Role of medical students in ending excess and stopping shortage: MedAID for International Need Edinburgh. Int J Surg 2018; 54:276-277. [DOI: 10.1016/j.ijsu.2018.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 05/02/2018] [Indexed: 10/16/2022]
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