Summary

Our results show that strategic instrument selection can contribute to lowering the environmental impact.

Abstract

Objectives
Shoulder surgery has a large environmental impact, which is partially caused by the sterilization of surgical instruments. This study examines the effect of optimizing surgical instrument trays for reversed shoulder arthroplasty (RSA), with the aim to reduce the environmental impact.

Methods

An adjusted Lean 5s method was used to optimize the number of instruments of shoulder arthroplasty specific trays. The five steps were ‘sort’, ‘simplify’, ‘sweep’, ‘standardize’ and ‘success’ and were used during four rounds. During these rounds the content of the instrument trays was discussed by two orthopedic surgeons, an orthopedic operation room assistant, the researcher, an expert from the Central Sterile Supply Department, a representative of the medical device company and a representative from the instrument tray manufacturer. A Life Cycle Assessment was used to calculate the environmental impact.

Results

139 of the 254 (55%) instruments were removed from the original RSA trays. Of the 139 removed instruments, 19 were put in a supplemental tray. The number of base trays was reduced from 10 to 3. The supplemental tray is expected to be opened in 6.67% of surgeries, because of needing bigger sizes. The estimated impact by eliminating these trays from the standard pre-operative setup, is 74.41 kg CO2-eq. annually.

Conclusion

This study confirms the feasibility of optimizing instrument trays for RSA, offering a straightforward method to reduce the environmental impact of shoulder surgery. Our results show that strategic instrument selection can contribute to lowering the environmental impact.