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Lean and Green: Minimizing Waste in Hand Surgery
Joelle Tighe, BS; David Brown, MD; Yaron Sela, MD; Mark E. Baratz, MD
University of Pittsburgh Medical Center, Pittsburgh, PA

Introduction: Costs associated with hospital waste disposal approximate million dollars, representing a significant portion of hospital resources. Approximately 30% of hospital waste is generated in operating rooms (ORs) representing a volume vastly disproportionate to their space utilization. Efforts to streamline OR processes and standardize practices has substantially increased waste production but may not benefit patient care or operating efficiency. Surgeon involvement is necessary to ensure patient safety and quality of care during coordinated efforts to improve efficiency and reduce the environmental burden of surgical procedures.
Materials & Methods: Routine hand surgeries appropriate to be performed under local anesthesia with a streamlined instrument set were identified. These included carpal tunnel releases, trigger finger releases, and cyst excisions. A subset of instruments necessary and adequate to perform these surgeries was culled from a standard instrument tray and processing costs determined. OR setup was altered to include minimal draping of the surgical field to reduce waste. Cases performed under local anesthetic using the streamlined hand pack were compared to similar cases performed under sedation using standard draping and instrumentation. Data from all applicable surgeries performed over nine months at a University-affiliated Surgery Center was collected to assess patient outcomes and measures of OR efficiency relevant to environmental impact. Red-bag and non-biohazard waste generated were weighed to the tenth of a pound to assess high-energy-disposal costs associated with biohazard materials. Two weeks post-operatively, patients rated their overall experience and anesthesia experience. Costs associated with performing surgery were determined from hospital charges and medical records.
Results: 67 cases performed under experimental conditions were compared with 103 cases performed with standard OR setup and sedation. Mean total weight of waste generated was 5.2kg for local cases and 5.6kg for sedation cases. The mean rating of overall surgical experience was 9.8 for both groups. The mean rating for anesthesia satisfaction was 9.7 for local and 9.2 with sedation.
Conclusions: While differences in trash generation, overall experience, and anesthetic satisfaction are not statistically significant, the immediate cost-savings are substantial. Standard cases cost more than double to setup with $230 in material costs versus $105 with easily streamlined processes. Furthermore, cases performed with local anesthetic avoided pre-operative testing and reduced overall costs by $791-$1,493 per case compared to using sedation which requires pre-operative physical, blood work, chest x-ray, EKG, and anesthesia. There were no differences in infection rate or recovery time.

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