Article Text
Abstract
Aim To investigate whether patient-specific instrumentation (PSI) and single-use instrumentation (SUI) improve operating room efficiency in terms of time and cost to the healthcare provider over conventional/reusable instrumentation (CVR) when performing total knee arthroplasty (TKA).
Patients and methods Patients requiring TKA were randomised into one of four surgical groups: CVR, CVS (conventional/SUI), PSR (PSI/reusable) and PSS (PSI/SUI). All surgical procedures were video recorded to determine specific surgical time intervals. Other variables reported included the number of instrument trays used, missing equipment, direct instrument costs and the weight of the instruments the staff had to handle. Oxford Knee Score (OKS), estimated blood loss and lengths of hospital stay were also recorded as markers of patient experience.
Results PSR was significantly quicker in all the recorded time intervals, used less trays, experienced less missing equipment and resulted in lower blood loss and shorter hospital stays. SUI reported significantly slower operating room times and resulted in higher blood loss, but SUI was 88% lighter and 20% cheaper on average when compared with their reusable counterparts. Despite the economic advantages of PSI and SUI, the patients who reported greatest improvements in OKS were those allocated to the CVR group, but no clinically meaningful difference in OKS was found at any time point.
Conclusions PSI and SUI for TKA have the potential of reducing operating room times over conventional, reusable sets. This reduction will benefit theatre personnel ergonomically, while presenting the healthcare provider with potential cost-saving benefits in terms of reduced sterilisation costs and surgical times.
- cost-effectiveness
- qualitative research
- randomised controlled trial
- surgery
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Footnotes
Contributors AA, GFT, MS, PRi, PRo and LCB made substantial contributions to the concept and design of the work. AA, GFT, MS and LCB acquired the data. Analysis and interpretation of the results were done by AA, GFT, MS, PRi, PRo and LCB. AA and GFT were responsible for writing the manuscript and MS, PRi, PRo and LCB critically revised it. AA, GFT, MS, PRi, PRo and LCB agreed on the final version of this manuscript. AA, GFT, MS, PRi, PRo and LCB agree to be accountable for all aspects of the work.
Funding The study was supported by the University of Strathclyde and Medacta International through a PhD studentship.
Competing interests LCB is on the speakers bureau at Medacta International.
Patient consent for publication Not required.
Ethics approval Ethical approval was obtained for this study by a local research ethics committee (REC reference: 15/SS/0058; IRAS ID: 177817).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data are available upon reasonable request.