Authors (including presenting author) :
Cheung A(1), Luk MH (1), Leung KCT(1), Lau CML(2), Chan PK(2), Chiu KY(2), Fu H(2)
Affiliation :
(1) Department of Orthopaedics and Traumatology, Queen Mary Hospital (2) Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong
Keyword 1: :
sustainability
Keyword 2: :
knee replacement
Keyword 3: :
knee arthroplasty
Introduction :
With the aging population, exponential increase in the demand for joint replacement surgery is expected in the coming decades. Knee replacements require vast amounts of disposable items as well as material and human resources for processing of reusable surgical instruments. Fortuitously, such procedures are routine in nature and provide ample opportunity for evaluation and streamlining.
Objectives :
1. Evaluate the amount of disposable and reusable items used during knee replacement surgery, 2. Quantify resource consumption and 3. To explore strategies to decrease wastage and boost efficiency.
Methodology :
A waste and surgical instrument audit was undertaken for 20 total and uni-compartmental knee replacements in Duchess of Kent Children’s Hospital. A custom drape set and Streamlined surgical instrument set was created based on this audit. The amount of waste generated, manpower costs, water and electricity consumption and carbon emissions associated with reprocessing of reusable surgical instruments was assessed for both the original arrangement and for the Streamlined surgical instrument sets.
Result & Outcome :
100 disposable items requiring 125 wrappers were used for each procedure. A custom knee replacement drape set was created and packaged at the manufacturing level and includes over 90% of draping material needed, requires only one external wrapper and costs HKD90 less than separate drapes. 109 instruments were originally prepared but, on average, only 47 items were utilised in each procedure. Based on actual surgeon usage patterns, the Streamlined instrument set was designed consisting of 53 items (48.6% of the original number of instruments). The Streamlined set weighs 41% of the weight of the original set (Streamlined set: 6.25kg, non-Streamlined set: 15.3kg). Processing of a single Streamlined and original instrument set generates 1.53 kg and 5.81 kg of CO2 emissions respectively. Extrapolating this for the period 2020-2024 during which 1934 knee replacement procedures were performed at DKCH, use of Streamlined sets resulted in a 73.7% reduction (7421.52 kg CO2e) in carbon emissions. Processing of the original instrument set requires 3.43 times the amount of water and electricity and the cost is 1.64 times that for Streamlined instruments (HKD230.1 v.s. 106.7 respectively). Use of custom drape set with Streamlined sets translates to cost savings of HKD388,053 (p=0.001) over a five-year period. In conclusion, substantial amounts of resources are consumed and waste is generated from knee replacement. Bespoke consumable and instrument sets can allow for more efficient use of material and human resources to allow for better sustainability.
