Surgical waste in a colorectal surgery operating room: A five-year experience

Background: Waste is a significant contributor to the high healthcare costs in the United States. We examined operating room waste among colorectal surgeries to determine surgical, provider or patient characteristic associations with the presence or extent of operating room waste. Additionally, we found disposable supplies (both sterile and non-sterile) to contribute to the highest proportion of waste. Methods: This is a retrospective cross-sectional analysis of the presence and extent of operating room waste identified within the supply chain linked with the electronic medical record and administrative billing data. All inpatient and outpatient colorectal surgery patients at our institution from January 1, 2012, were included through May 31, 2017. Co-managed cases (general surgeon as primary surgeon) were excluded. Waste items included: contaminated, implanted and removed, unsatisfactory or outdated, wrongly opened, opened and unused, and items that could not be returned when the procedure or surgeon changed, or the case was canceled. Chi-square tests were used to assess risk factors associated with the presence of waste, while Kruskal-Wallis tests were used for the extent of waste (percent of supply costs). Results: 3297 colorectal surgery cases were performed over 5+ years. Out of those, 730 (22.1%) had a mean of 2.9 items per case identified as "wasted," representing 5.8% of all supply costs for these surgeries. The top five variables associated with waste included: surgical duration, age group of the patient, weekday surgery, surgical category, and ASA class. Surgical duration had the strongest association, followed by the patient's age group, day of surgery, surgical category, and ASA class in descending order. Conclusions: Although a small percentage of operative supplies are wasted in this practice, nationally, surgical waste may substantially contribute to total healthcare costs. Differences across surgeons and types of surgeries suggest that opportunities exist to reduce OR supply waste and cost.