The SLIM Study: Economic, Energy, and Waste Savings Through Lowering of Instrumentation Mass in Total Hip Arthroplasty

Background: Nearly 700,000 total hip arthroplasties (THAs) are annually performed in North America, costing the healthcare system >$15 billion and creating over 5 million tons of waste. This study aims to (1) assess satisfaction of current THA setup; (2) determine economic cost, energy cost, and waste cost of current setup and apply lean methodology to improve efficiency; and (3) design and test Savings through Lowering of Instrumentation Mass (SLIM) setup based on lean principles and its ability to be safely implemented into practice. Methods: A Needs Assessment Survey was performed. After review and surgeon input, the SLIM set was designed, significantly reducing redundancy. Eighty patients were randomized to either Standard or SLIM setup. Operating room time, blood loss, perioperative adverse events and complications, cost/case, instrument weight (kg/case), total waste (kg/case), case setup time, and number of times and number of extra trays required were compared between groups. Results: The SLIM setup was associated with the following savings: Cost = -$408.19/case; Energy = -7.16 kWh/case; Waste = -1.61 kg/case; Trays = -6 (758 kg/case). No differences in operating room time, blood loss, and complication rate were detected (P >.05) between groups. Setup time was significantly shorter with SLIM (P <.05) and extra instrumentation was opened in <5% of cases. Conclusion: A more minimalist approach to THA can be safely implemented. The SLIM setup is efficient and has been openly accepted by our allied staff. Such setup can lead to 1,610 kg reduction in waste, 7,160 kWh, and $408,190 in savings per 1,000 THAs performed. Crown Copyright (C) 2022 Published by Elsevier Inc. All rights reserved.

Automated summary

This study aims to improve efficiency and cost-effectiveness of total hip arthroplasty (THA) by simplifying the instrument setup. The study found that adopting a more minimalist approach to instrument setup can lead to significant savings in cost, energy, and waste, without compromising surgical time and patient safety.