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Surgical Tray Optimization in the Setting of Cleft Lip and Palate Reconstruction: Implications for Operative Cost, Efficiency, and Global Health
Matteo Laspro
*, Leya Groysman, Liliana Camison-Bravo, David Staffenberg, Roberto L. Flores
Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine, New York, NY
Introduction: Healthcare expenditure accounts for over 15% of the US Gross Domestic Product. Surgical interventions and operative room utilization have been pointed out as major contributors to such value. Understanding instrument use in reconstructive cleft lip and palate could serve as a proxy for sustainability in plastic surgery. This study aims to calculate the utilization fraction (UF) of surgical instruments in cleft lip and cleft palate interventions. We hope to assess instrument usage and create an optimized surgical tray that could serve as a template for local and global cleft centers.
Methods: The utilization of surgical instruments in cleft lip and palate surgeries was collected from 03/2024 to 05/2024. The authors carried initial pre-incision clefting instrument counts of all surgical trays opened. After case finalization, the used instruments were counted. UF was calculated as the percent of averaged used instruments to averaged opened instruments per case. New optimized cleft and palate surgical trays were idealized by removing instruments not used in 20% of cases. Using pre- and post-optimized surgical trays, a cost analysis was performed. In our institution, the reprocessing cost is $1.56 per instrument.
Results: 5 cleft lip and 3 cleft palate interventions were queried. An average of 85 and 75 instruments were opened for cleft lip and palate interventions, respectively, with an average of 17.5 and 13 instruments being utilized. This yielded a UF of 23.3% and 17.3%, respectively. The cost for tray reprocessing for each respective intervention was $132.6 and 117 before optimization. After new tray creations, the instrument number decreased to 36 and 24 in cleft lip and palate trays. Reprocessing costs decreased to $56.2 and 37.4 following optimization.
Conclusion: Our study suggests excessive superfluous surgical material in cleft lip and palate cases. Orofacial clefting tray optimization has a positive cost and sustainability impact. Reduced tray number may be beneficial to low-resource surgical centers.
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