Surgical tray optimization: a prospective and survey-based evaluation of environmental and economic outcomes

Abstract

Background: Operating rooms are resource-intensive environments. While reusable instruments are more sustainable than disposables, sterilization and reprocessing of unused instruments in the trays generate unnecessary environmental and financial burdens. Surgical tray optimization-removal of rarely used instruments-may reduce these impacts. Current evidence is fragmented, with no standard method to identify unused instruments and limited integration of environmental and cost analyses.

Methods: We prospectively recorded instrument use for the Major General Surgery tray (94 reusable instruments) in one academic hospital in the Netherlands during 162 surgical procedures across multiple disciplines (November 2023-May 2024). Instruments used in < 20% of cases were considered for removal by (1) prospective clinical observation and (2) retrospective staff survey (surgeons, residents, scrub nurses). Life cycle assessment (LCA) and activity-based costing quantified the carbon footprint and costs.

Results: On average, 19 instruments were used per case; 10 were never used. Observation-based optimization reduced tray size and weight by 54%, lowering costs by 55%. Survey-based review achieved smaller reductions (22% in number, 18% in weight, 21% in cost), with surgeons supporting more removals than scrub nurses. The original tray generated 1.25 kg CO2-eq per use. Optimization reduced emissions by 0.91 and 2.69%, corresponding to thresholds of < 10 and < 20% use, respectively. Conclusion: In multi-specialty settings, tray optimization offers substantial cost savings and modest but cumulative environmental benefits. Clinical observation identified greater reductions than staff reviews. Combining LCA with cost analysis can provide a transparent framework to guide sustainable surgical practice.