Inaccurate preference cards & disposable supplies: A $5 billion per year problem

Of the estimated $3.6 trillion spent on US healthcare in 2019, approximately one-third was attributable to surgical services. Operating rooms account for 60% of total hospital operational expense [1] and disposable surgical supplies constitute at least 50-60% of the OR budget [2].

Unfortunately, anyone who has worked in the OR will attest that a significant proportion of those supplies are wasted (opened for surgery but not used and therefore discarded). Moreover, there are additional labor and personnel costs associated with returning supplies to inventory that were picked but unused. Clearly, this represents a significant potential opportunity to achieve systematic reduction of healthcare costs on a national level.

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The fundamental cause of this circumstance is multi-faceted but is rooted in the archaic approach still taken by the majority of US hospitals in managing surgeon preference cards. In fact, studies have found that an estimated $5 billion per year is wasted on supplies due to inaccurate and outdated preference cards [3].

Preference cards generally contain 20-40% more supplies than are actually required for a given case [4]. Typically, there is a reported waste of $50 to $150 per case of opened, but unused disposable supplies; however, one study found an estimated average disposable supply waste of $968 per neurosurgery case [5]. Of note, any study on this topic will tend to underestimate the true OR waste as a result of selection bias and the presence of direct observers modifying the behavior of OR team members.

Moreover, most surgeons do not currently receive the information necessary to consider cost as one of the factors in the decision-making process for which items to include on their preference cards. There is a growing body of evidence supporting that when surgeons are provided with pricing transparency, there is a shift toward a better value selection of disposable supplies.

The current systems in place for managing preference cards is suboptimal for a variety of reasons, but there is a clear need for a methodology that is driven by actual usage data in order to minimize waste and reduce labor-related inefficiency, while preserving high quality of care. Actual usage data would both inform and support the surgeon’s decision-making process for what should be included on the preference card and therefore which disposable supplies should be opened (or made available and held) for a given case.

All of that considered, the opportunity is promising since, on average, 85% of OR waste is from individual disposable items [5], rather than those included in pre-fabricated surgical packs. The key limitation faced by efforts to remedy this situation is the lack of accurate, reliable data on actual disposable supply usage in the OR. Those data are not reliably captured by electronic health records or inventory management systems. Published studies on efforts to address these issues have depended on direct observation and manual collection of those data points, which is a time-consuming and resource-intensive paradigm that is not sustainable for most hospitals.

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OpFlow is focused on improving efficiency and reducing costs related to surgery. Our innovative approach begins with optimizing surgical instrumentation and proceeds from there to address waste associated with disposable supplies and materials. Implementation of the comprehensive OpFlow platform ensures sustainment of those gains and ongoing enhancement of the delivery of surgical care.

1. Weiss A, et. al. Environmentalism in surgical practice. Curr Prob Surg. 2016 ;53(4):165–205.

2. de Sa D, et. al. The direct environmental impact of hip arthroscopy for femoroacetabular impingement: a surgical waste audit of five cases. JHip Preserv Surg. 2016;3(2):132-137.

3. https://www.medtronic.com/us-en/transforming-healthcare/aligning-value/perspective/case-studies/ihs-surgeon-preference-cards.html

4. Moons K, et. al. Measuring the logistics performance of internal hospital supply chains — a literature study. Omega (2018) 1–13.

5. Zygourakis CC, et. al. Operating room waste: disposable supply utilization in neurosurgical procedures. J Neurosurg.2017 Feb;126(2):620-625.