The Reduction of Implant-Related Errors and Waste in Total Knee Arthroplasty Using a Novel, Computer Based, e.Label and Compatibility System

doi:10.1016/j.arth.2013.03.013

The Journal of Arthroplasty

Volume 29, Issue 1, January 2014, Pages 132-136

https://doi.org/10.1016/j.arth.2013.03.013 Get rights and content

Abstract

Implant related errors and wasted arthroplasty implants represent a significant problem in the healthcare system. Studies estimate that an implant is wasted in two to five percent of total joint replacement procedures. After the introduction of a standardized time-out procedure, our institution still had a wasted implant in one out of every 20 arthroplasty surgeries. We then implemented a computer based, e.Label and compatibility system which standardized the implant labeling, confirmed correct size and side, and ensured compatibility within implant systems. Use of this system decreased wasted implants from 5.7% to 0.8% of total knee arthroplasty cases. This translated to an annualized cost savings of over $75,000 over our study period which could extrapolate to over $82 million per year in savings to the US healthcare system.

Section snippets

Methods and Materials

Prior to the initiation of this study, our institution recognized the danger of implant errors as well as the importance of wasted implants. A “time-out” procedure had been implemented to stop the surgical procedure and to ensure that all implants were inspected by the entire operating room staff, including the operating surgeon, prior to opening of the boxes. A 32 inch flat panel monitor was installed in each operating room and connected to a video camera that was used to project the box

Methods for Cost Analysis

Costs were analyzed using two methods to estimate the cost of wasted implants during total knee arthroplasty. The first is based on the list price of the implants available from the manufacturer. However, since prices paid for implants can vary between hospitals and individual hospital costs are kept confidential, the data were then re-analyzed using the United States average implant costs as presented by Robinson et al in 2012 [3]. They reported the average range for the cost of implants for

Results

Hand written implant waste logs from April 2011 to May 2012, representing the time period before the implementation of the computer based e-Label and compatibility system, were reviewed and wasted total knee arthroplasty implants were recorded. The logs from February 2012 were unavailable for review because they had been lost. This brought the total retrospective review to a time period of 12 months. During this time period there were 83 wasted implants in 1,450 surgeries performed by the study

Discussion

The prevention of medical errors and the reduction of waste in the provision of healthcare has been a focus of public health debate and regulatory policy in the United States for the past decade. Since the release of To Err is Human: Building a Safer Healthcare System in November of 1999, much attention has been given to the need to reduce medical errors in our healthcare system [4]. More recently, as the financial viability of our healthcare system has been questioned, the focus has been not

Acknowledgments

The authors would like to thank Dr. Mathias Bostrom for his assistance with this study.

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An AOA Symposium Patient Safety in North America: Beyond “Operate Through Your Initials” and “Sign Your Site”
J Bone Joint Surg Am
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Variability in Costs Associated with Total Hip and Knee Replacement Implants
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There are more references available in the full text version of this article.

Cited by (10)

What is the cost burden of surgical implant waste? An analysis of surgical implant waste in an orthopedics and trauma surgery department of a French university hospital in 2016
2019, Orthopaedics and Traumatology: Surgery and Research
Citation Excerpt :
Several teams, especially in the United States, have looked into issues surrounding surgical implant waste. They found significant reductions in the quantity and cost after an awareness program was implemented for operating room staff [6–10]. Epstein et al. [10] showed that training for neurosurgeons helped to reduce the surgery costs during cervical discectomy from 20% to 5.8%.
During an orthopedic or trauma surgery procedure, when an implantable medical device is unpackaged, not implanted and cannot be resterilized, it is considered “waste”. The cost burden falls on the hospital. The French Social Security Code provides for add-on reimbursement for certain expensive or very specialized devices (supplementary list of costly implants). To allow its restocking without linking it to a patient or reimbursement request, the wasted implant is tracked in a computerized database. The economic impact of these wasted implants is not known in France. This led us to conduct a retrospective study: 1) to determine the percentage and number of wasted implants, 2) to identify elements related to the surgery that impact implant waste.
Various elements of the surgical environment (type of procedure, specialty, surgeon experience, time of year) can independently contribute to the non-implantation of a medical device.
We carried out a retrospective observational study of data collected prospectively in the database of our teaching hospital in 2016. The primary outcome was the percentage of wasted implants. The secondary outcome was the mean cost of these wasted implants. These parameters were determined for all the implants used in orthopedics and trauma surgery and tracked in this department, then for each variable hypothesized to led to non-implantation. Our analysis was descriptive, then comparative.
In our database, 29,073 devices were tracked (€3,761,180), of which 1995 devices were wasted (6.9%). The total cost of the wasted implants was €179,193 (4.8% of the overall cost). The breakdown of the wasted implants was 430 (4.4%) from the add-on list (average cost of €293.10) versus 1565 implants associated with the hospital's diagnosis-related group payment system (average cost of €33.90). Trauma surgery procedures had significantly more wasted implants than orthopedic surgery (1135 vs. 860 (p < 0.01)), although the individual cost was less (€59.20 vs. €130.10 (p < 0.01)). Fracture fixation implants were more likely to be wasted than ligament reconstruction or arthroplasty implants, with a lower mean cost. More implants were wasted during hip arthroplasty than during other arthroplasty procedures. Less experienced surgeons wasted more implants than more experienced surgeons (1087 vs. 905 (p < 0.01)) but these implants cost less (€69.20 vs. €114.80 (p < 0.05)). The percentage of implants wasted was higher during the resident changeover period relative to the other months of the year (772 vs. 1223 (p < 0.01)).
This study is the first attempt at quantifying the number and cost of wasted implants in the context of orthopedics and trauma surgery at a teaching hospital in France. While trauma surgery is associated with more wasted implants, the cost burden is higher in orthopedics. Surgeons, by virtue of their experience and teaching mandate, have a decisive role managing this cost burden.
IV, Retrospective study.
What is the cost burden of surgical implant waste? An analysis of surgical implant waste in an orthopedics and trauma surgery department of a French university hospital in 2016
2019, Revue de Chirurgie Orthopedique et Traumatologique
Au cours d’une intervention chirurgicale d’orthopédie-traumatologie, lorsqu’un Dispositif Médical Implantable (DMI) est déstérilisé, non implanté, et non restérilisable, celui-ci est dit « jeté ». Il s’agit d’une perte financière pour l’établissement. Pour des raisons de coût ou de spécificité, le Code de la Sécurité Sociale prévoit le remboursement de certains DMI (dits « hors GHS ») sous conditions. Afin d’en permettre le réapprovisionnement sans l’associer à un patient ni en demander le remboursement, l’implant jeté est tracé informatiquement. Les données économiques liés à ces implants jetés ne sont aps connus en France, aussi nous avons mené une étude rétrospective afin : 1) d’évaluer la proportion et le montant des DMI tracés « jetés », 2) d’identifier les éléments en lien avec le contexte chirurgical influençant la proportion de DMI jetés.
Des éléments du contexte chirurgical (type d’activité, spécialité de l’implant, statut du chirurgien, période de l’année) peuvent de manière indépendante aboutir à la non implantation d’un DMI ?
Nous avons conduit une étude observationnelle rétrospective de données collectées prospectivement à partir de la base de données du Centre Hospitalo-Universitaire sur l’année 2016. Le critère principal d’évaluation était la proportion de DMI tracés « jetés ». Le second critère d’évaluation était le coût moyen par DMI tracés « jetés ». Ces critères ont été mesurés sur l’ensemble des DMI d’orthopédie-traumatologie tracé dans ce bloc puis pour chaque élément d’hypothèse pouvant aboutir à la non implantation. L’analyse a d’abord été descriptive puis comparative.
Vingt-neuf mille et soixante treize DMI ont été tracés (3 761 180 €), dont 1995 DMI tracés « jetés » (6,9 %). Le montant total des implants jetés était de 179 193 € (4,8 % du montant total). Quatre cent-trente DMI hors GHS ont été tracés « jetés » (4,4 %) pour un montant moyen de 293,1 € contre 1565 DMI intra GHS (33,9 €). La traumatologie était significativement plus pourvoyeuse d’implants jetés que l’orthopédie (1135 vs 860 (p < 0,01)), pour un montant plus faible (59,2 € vs 130,1 € (p < 0,01)). Les implants d’ostéosynthèse étaient plus jetés que les implants de ligamentoplastie ou d’arthroplastie, pour un montant moyen inférieur. Il y avait plus de DMI jetés au cours des poses de prothèses de hanche par rapport aux autres prothèses. Les chirurgiens les moins expérimentés ont jetés plus souvent (1087 vs 905 (p < 0,01)) mais pour un coût moindre (69,2 € vs 114,8 € (p < 0,05)). Lors des périodes de changement d’internes, il y a eu une augmentation de la proportion de DMI jetés par rapport aux autres périodes de l’année (772 vs 1223 (p < 0,01)).
Cette étude a permis de quantifier pour la première fois le nombre et le montant des DMI jetés en orthopédie-traumatologie dans un service hospitalo-universitaire. La traumatologie est plus pourvoyeuse d’implants jetés tandis que l’impact financier est plus important en orthopédie. Le chirurgien, de par son expérience et ses missions d’enseignement, a un rôle déterminant dans la gestion des pertes financières.
IV, étude rétrospective.
Contributing to the Value Equation: How Uniform Musculoskeletal Implant Labeling Could Improve Quality and Decrease Costs for Orthopaedic Patients
2017, Operative Techniques in Orthopaedics
Value in health care is affected by the quality of care provided divided by its cost. This article reviews the published literature related to orthopaedic implant waste, its potential contributing factors, and the effect on quality related to improper implant selection. It concludes by reviewing developed international standards around uniform implant labeling and discusses how uniform labeling can benefit human-based selection errors based on human factors engineering principles.
Analysis of Medication and Procedure Complications in Hospitalized Iranian Patients
2022, Journal of Health Sciences and Surveillance System
Never events in orthopaedics: A nationwide data analysis and guidance on preventative measures
2021, International Journal of Risk and Safety in Medicine
Implant wastage in orthopaedic trauma: A UK experience
2020, Annals of the Royal College of Surgeons of England

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: The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2013.03.013.

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The Journal of Arthroplasty

Abstract

Section snippets

Methods and Materials

Methods for Cost Analysis

Results

Discussion

Acknowledgments

References (10)

Incidence and Cost of Intraoperative Waste of Hip and Knee Arthroplasty Implants

J Arthroplasty

An AOA Symposium Patient Safety in North America: Beyond “Operate Through Your Initials” and “Sign Your Site”

J Bone Joint Surg Am

Variability in Costs Associated with Total Hip and Knee Replacement Implants

J Bone Joint Surg Am

To Err is Human: Building a Safer Healthcare System

"Front Matter." Best Care at Lower Cost: The Path to Continuously Learning Health Care in America

Cited by (10)

What is the cost burden of surgical implant waste? An analysis of surgical implant waste in an orthopedics and trauma surgery department of a French university hospital in 2016

What is the cost burden of surgical implant waste? An analysis of surgical implant waste in an orthopedics and trauma surgery department of a French university hospital in 2016

Contributing to the Value Equation: How Uniform Musculoskeletal Implant Labeling Could Improve Quality and Decrease Costs for Orthopaedic Patients

Analysis of Medication and Procedure Complications in Hospitalized Iranian Patients

Never events in orthopaedics: A nationwide data analysis and guidance on preventative measures

Implant wastage in orthopaedic trauma: A UK experience