American Association for Hand Surgery

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Cost Analysis of Radiofrequency Identification Instrument Tracking for Surgical Tray Optimization in Carpometacarpal Arthroplasty
Elliot Le, B.S.1, Joshua Helmkamp, BA1, Ian Hill, MS2, Rachel E Hein, MD3, Aman Bali, BA1, Philip Koury, HS4, Suhail Kamrudin K. Mithani, MD5, Patrick Codd, MD1 and Marc J. Richard, MD3, (1)Duke University School of Medicine, Durham, NC, (2)Duke University Pratt School of Engineering, Durham, NC, (3)Duke University Medical Center, Durham, NC, (4)Duke University, Durham, NC, (5)Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC


Surgical care is a major driver of rising healthcare costs, and surgical instrument oversupply is a significant contributor. Surgical inventory management should balance the assurance of instrument availability with cost minimization. Prior efforts to standardize surgical tray composition through preference cards or expert panels are resource intensive and are not data-driven. The purpose of this study is to generate a streamlined surgical tray using instrument-use data through a radiofrequency identification (RFID) instrument tracking system in carpometacarpal (CMC) arthroplasties as well as demonstrate the potential cost savings of such a solution.


RFID-tags were affixed to surgical instruments in the orthopaedic hand tray used for CMC arthroplasty procedures. An antenna connected to an RFID reader was placed underneath the surgical site. Each time an RFID tagged instrument passed over the antenna, software logged its use. Our study included ten procedures by two different surgeons at Duke University Ambulatory Surgical Center (ASC) using this tracking system. After nine of the ten cases, the instrument tray was reduced based on the system-gathered instrument-use data. A cost analysis was conducted with Duke-specific cost values and costs derived from a literature review. Costs associated with surgical instrument management included sterilization, processing, packaging, refurbishment, and replacement.


Over half (51%) of the instruments in the tray were unused in all monitored cases. In the case utilizing the reduced tray, no additional instruments were requested. Cost analysis demonstrated that reducing tray size may result in potential cost savings of $6,200 annually for CMC arthroplasties alone. For an ASC conducting 5,000 operations per year, extrapolated savings would be greater than $100,000 per year.


An RFID surgical instrument tracking system can serve as a novel data source with a wide variety of potential applications. We demonstrated its successful use in decreasing unnecessary instrumentation for a common surgical procedure.

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