Health costs and efficiencies of patient-specific and single-use instrumentation in total knee arthroplasty: a randomised controlled trial

Andre Attard, Gwenllian Fflur Tawy, Michiel Simons, Philip Riches, Philip Rowe, Leela C Biant

Research output: Contribution to journalArticle

Abstract

Aim
To investigate whether patient-specific instrumentation (PSI) and single-use instrumentation (SUI) improve operating room efficiency in terms of time and cost to the healthcare provider over conventional/reusable instrumentation (CVR) when performing total knee arthroplasty (TKA).
Patients and methods
Patients requiring TKA were randomised into one of four surgical groups: CVR, CVS (conventional/SUI), PSR (PSI/reusable) and PSS (PSI/SUI). All surgical procedures were video recorded to determine specific surgical time intervals. Other variables reported included the number of instrument trays used, missing equipment, direct instrument costs and the weight of the instruments the staff had to handle. Oxford Knee Score (OKS), estimated blood loss and lengths of hospital stay were also recorded as markers of patient experience.
Results
PSR was significantly quicker in all the recorded time intervals, used less trays, experienced less missing equipment and resulted in lower blood loss and shorter hospital stays. SUI reported significantly slower operating room times and resulted in higher blood loss, but SUI was 88% lighter and 20% cheaper on average when compared with their reusable counterparts. Despite the economic advantages of PSI and SUI, the patients who reported greatest improvements in OKS were those allocated to the CVR group, but no clinically meaningful difference in OKS was found at any time point.
Conclusions
PSI and SUI for TKA have the potential of reducing operating room times over conventional, reusable sets. This reduction will benefit theatre personnel ergonomically, while presenting the healthcare provider with potential cost-saving benefits in terms of reduced sterilisation costs and surgical times.
LanguageEnglish
Article numbere000493
JournalBMJ Open Quality
Volume8
Issue number2
Early online date29 May 2019
DOIs
Publication statusE-pub ahead of print - 29 May 2019

Fingerprint

Knee Replacement Arthroplasties
Health Care Costs
Randomized Controlled Trials
Operating Rooms
Length of Stay
Knee
Operative Time
Costs and Cost Analysis
Health Personnel
Equipment and Supplies
Cost-Benefit Analysis
Economics
Weights and Measures

Keywords

  • total knee arthroplasty
  • surgical instrumentation
  • patient specific instrumentations
  • single use instrumentation
  • recovery

Cite this

@article{63cb1d504fb34b33bab8156425584ed0,
title = "Health costs and efficiencies of patient-specific and single-use instrumentation in total knee arthroplasty: a randomised controlled trial",
abstract = "Aim To investigate whether patient-specific instrumentation (PSI) and single-use instrumentation (SUI) improve operating room efficiency in terms of time and cost to the healthcare provider over conventional/reusable instrumentation (CVR) when performing total knee arthroplasty (TKA).Patients and methods Patients requiring TKA were randomised into one of four surgical groups: CVR, CVS (conventional/SUI), PSR (PSI/reusable) and PSS (PSI/SUI). All surgical procedures were video recorded to determine specific surgical time intervals. Other variables reported included the number of instrument trays used, missing equipment, direct instrument costs and the weight of the instruments the staff had to handle. Oxford Knee Score (OKS), estimated blood loss and lengths of hospital stay were also recorded as markers of patient experience. Results PSR was significantly quicker in all the recorded time intervals, used less trays, experienced less missing equipment and resulted in lower blood loss and shorter hospital stays. SUI reported significantly slower operating room times and resulted in higher blood loss, but SUI was 88{\%} lighter and 20{\%} cheaper on average when compared with their reusable counterparts. Despite the economic advantages of PSI and SUI, the patients who reported greatest improvements in OKS were those allocated to the CVR group, but no clinically meaningful difference in OKS was found at any time point.Conclusions PSI and SUI for TKA have the potential of reducing operating room times over conventional, reusable sets. This reduction will benefit theatre personnel ergonomically, while presenting the healthcare provider with potential cost-saving benefits in terms of reduced sterilisation costs and surgical times.",
keywords = "total knee arthroplasty, surgical instrumentation, patient specific instrumentations, single use instrumentation, recovery",
author = "Andre Attard and Tawy, {Gwenllian Fflur} and Michiel Simons and Philip Riches and Philip Rowe and Biant, {Leela C}",
year = "2019",
month = "5",
day = "29",
doi = "10.1136/bmjoq-2018-000493",
language = "English",
volume = "8",
journal = "BMJ Open Quality",
issn = "2399-6641",
number = "2",

}

Health costs and efficiencies of patient-specific and single-use instrumentation in total knee arthroplasty : a randomised controlled trial. / Attard, Andre; Tawy, Gwenllian Fflur; Simons, Michiel; Riches, Philip; Rowe, Philip; Biant, Leela C.

In: BMJ Open Quality, Vol. 8, No. 2, e000493, 29.05.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Health costs and efficiencies of patient-specific and single-use instrumentation in total knee arthroplasty

T2 - BMJ Open Quality

AU - Attard, Andre

AU - Tawy, Gwenllian Fflur

AU - Simons, Michiel

AU - Riches, Philip

AU - Rowe, Philip

AU - Biant, Leela C

PY - 2019/5/29

Y1 - 2019/5/29

N2 - Aim To investigate whether patient-specific instrumentation (PSI) and single-use instrumentation (SUI) improve operating room efficiency in terms of time and cost to the healthcare provider over conventional/reusable instrumentation (CVR) when performing total knee arthroplasty (TKA).Patients and methods Patients requiring TKA were randomised into one of four surgical groups: CVR, CVS (conventional/SUI), PSR (PSI/reusable) and PSS (PSI/SUI). All surgical procedures were video recorded to determine specific surgical time intervals. Other variables reported included the number of instrument trays used, missing equipment, direct instrument costs and the weight of the instruments the staff had to handle. Oxford Knee Score (OKS), estimated blood loss and lengths of hospital stay were also recorded as markers of patient experience. Results PSR was significantly quicker in all the recorded time intervals, used less trays, experienced less missing equipment and resulted in lower blood loss and shorter hospital stays. SUI reported significantly slower operating room times and resulted in higher blood loss, but SUI was 88% lighter and 20% cheaper on average when compared with their reusable counterparts. Despite the economic advantages of PSI and SUI, the patients who reported greatest improvements in OKS were those allocated to the CVR group, but no clinically meaningful difference in OKS was found at any time point.Conclusions PSI and SUI for TKA have the potential of reducing operating room times over conventional, reusable sets. This reduction will benefit theatre personnel ergonomically, while presenting the healthcare provider with potential cost-saving benefits in terms of reduced sterilisation costs and surgical times.

AB - Aim To investigate whether patient-specific instrumentation (PSI) and single-use instrumentation (SUI) improve operating room efficiency in terms of time and cost to the healthcare provider over conventional/reusable instrumentation (CVR) when performing total knee arthroplasty (TKA).Patients and methods Patients requiring TKA were randomised into one of four surgical groups: CVR, CVS (conventional/SUI), PSR (PSI/reusable) and PSS (PSI/SUI). All surgical procedures were video recorded to determine specific surgical time intervals. Other variables reported included the number of instrument trays used, missing equipment, direct instrument costs and the weight of the instruments the staff had to handle. Oxford Knee Score (OKS), estimated blood loss and lengths of hospital stay were also recorded as markers of patient experience. Results PSR was significantly quicker in all the recorded time intervals, used less trays, experienced less missing equipment and resulted in lower blood loss and shorter hospital stays. SUI reported significantly slower operating room times and resulted in higher blood loss, but SUI was 88% lighter and 20% cheaper on average when compared with their reusable counterparts. Despite the economic advantages of PSI and SUI, the patients who reported greatest improvements in OKS were those allocated to the CVR group, but no clinically meaningful difference in OKS was found at any time point.Conclusions PSI and SUI for TKA have the potential of reducing operating room times over conventional, reusable sets. This reduction will benefit theatre personnel ergonomically, while presenting the healthcare provider with potential cost-saving benefits in terms of reduced sterilisation costs and surgical times.

KW - total knee arthroplasty

KW - surgical instrumentation

KW - patient specific instrumentations

KW - single use instrumentation

KW - recovery

U2 - 10.1136/bmjoq-2018-000493

DO - 10.1136/bmjoq-2018-000493

M3 - Article

VL - 8

JO - BMJ Open Quality

JF - BMJ Open Quality

SN - 2399-6641

IS - 2

M1 - e000493

ER -