Too often, McGuire says, there is "intra-operative waste," which he and his colleagues describe as any item "wasted when it was prepared or opened during a case, but was ultimately not used or implanted and could not be subsequently used or implanted in a different patient."
What's the main driver of the cost burden? In the parlance of McGuire's study, it is simply stated as "surgeon changed mind."
In the Beth Israel Deaconess study, items improperly wasted included surgical implant devices, bone graft devices, and miscellaneous other material such as drapes, gowns, globes, sponges, sutures, and drains. A surgeon's change of mind accounted for 44% of the wasted items, and "contamination" for 27% of disposals. Other reasons for waste were "equipment failure/technical difficulties," items "opened by mistake," and "case cancellation."
"When we say 'waste,' it was something paid for, charged to the hospital, and it wasn't utilized in another patient. It was basically removed or thrown into the trash. That's waste," McGuire says. "In our environment, any of that wasted instrument is paid for by the hospital but not charged to the insurance company because it's all under the DRG [diagnosis-related group] payment system. That's why the word 'waste' is utilized."
Some level of waste is normal, "especially at level-one academic centers, since you are doing multilevel complex cases," McGuire says. "There is a significant number of older patients who have osteoporosis; you put a screw in and you engage it and tighten it down, it doesn't fit, wrong size, and so there will be an incidence of waste."
Because there are so many variations of waste, physicians weren't exactly sure how to define it properly when they began their study, McGuire says. "We realized that there was no clear definition of what constituted a wasted implant," he wrote in a blog. To get to the root of the problem, they asked surgeons, operating room personnel, industry representatives, and nurses to help them pinpoint areas of waste that should be eliminated from operating rooms.