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The cost of surgical procedures can be an emotive and politically charged topic, and as a result healthcare practitioners seek efficiencies to reduce costs across the board while at the same time not compromising surgical efficacy or patient safety. One particular area of debate is the cost of single-use surgical instruments when compared to sterilising reusable surgical instruments for multiple operations, and this article will attempt to compare the overall costs behind both options.

How Does One Compare The Cost Of Single-Use Surgical Instruments Over Reusable Ones?

Calculating the real cost per use of single-use surgical instruments is easy by their very nature. You multiply the cost of the number of single-use surgical instruments used in a surgical procedure with the unit price of the single-use surgical instrument, and you have an accurate picture of the cost per surgical procedure type. You may want to factor in disposal costs and the administrational costs (such as the time of the purchasing manager to source the product and place the order), but these are fairly marginal and absorbed into existing processes and procedures in most healthcare institutions.

Calculating the costs of reusable surgical instruments is much more opaque, not only because different reusable instruments will only be able to be reused a certain number of times, and this differs between instruments, but there are also a number of not-so-hidden costs that don’t always get factored into the overall cost of reusable surgical instruments when in fact they should.

That said, a study analysing the cost and operational performance of disposable versus reusable forceps calculated the total cost per use of the disposable forceps as just $38. The cost per use for the reusable forceps came in at as much as $415.

The Not-So-Hidden Costs Of Reusable Surgical Instruments

At its simplest calculation, the superficial cost of any one reusable surgical instrument should be the cost of the instrument times its cost times the number of times it can be used. However, this is an inaccurate calculation for many reasons.

First of all, for the instrument to be used repeatedly, it has to be sterilised and cleaned, and this comes at a cost to the institution reusing surgical instruments. Connected with this are the logistical aspects and errors that come with using reusable instruments, which are involved in managing the journey of the reusable surgical instrument from surgery to sterilisation unit and then back to surgery (possibly via a storage unit along the way). It would come as no surprise that in large institutions, such as hospitals, things like reusable surgical instruments go missing (thereby negating the cost benefit of buying reusable products in the first place).

Secondly, the efficacy of reusable surgical instruments over a period of time and other potential pitfalls with using them add substantial hidden costs and identifiable risks with their use. For example, would a reusable surgical instrument perform as effectively on its 30th time as on its first? Also, actually how effective are the resterilisation processes behind reusable surgical instruments and, if they are ineffective, what are the costs to healthcare institutions and healthcare practitioners in dealing with any cross infection between patients?

The Risk & Cost Of Cross Infection

In one particular aspect, it is hard to calculate the cost of a cross infection caused by reusable surgical instruments because it is entirely dependent on what infection has been transmitted and what it costs to counteract or treat. In any event, there is always a risk to a patient as no institution can guarantee a 100% success rate when resterilising medical instruments, and what cost do you attribute to a patient’s ongoing safety and health as a result?

That being said, there have been studies undertaken to look at the cost to institutions of surgical site contamination. Of course, such contamination may result from other factors arising aside from the presence of reusable surgical instruments, but given that such instruments have been used directly on one patient and then another, the risk is always present and dependent on the success of the sterilisation process in between.

However, according to NICE (National Institute for Health and Care Excellence), “Surgical site infections have been shown to compose up to 20% of all healthcare-associated infections. At least 5% of patients undergoing a surgical procedure develop a surgical site infection while another study claimed “Surgical site infection accounts for about 16% of all healthcare-associated infections in England”. The use of single-use surgical instruments would certainly help minimise these risks as, by their nature, they have not been used before and are sterile before opening. The same cannot be said of reusable surgical instruments.

The Pounds & Pence Cost To The NHS Of Surgical Site Infection

While the incidence and accuracy of surgical site infection remains contentious in some quarters, some conservative costs can be calculated. Even if the numbers are understated, surgical site infection represents a significant cost to the NHS, ranging from £2,100 to £10,500 per infection depending on the nature of the surgery according to NICE. Expert opinion suggests that costs can be as high as £20,000 per surgical site infection for complex surgery and up to £14,000 for more general surgery.

It has also been estimated that the cost to the NHS of surgical site infections is around £700m a year. Treatment of patients with surgical site infection also reduces the capacity to treat other patients, creating a further inefficiency.

As you can see, there is a ‘domino effect’ at work with cross infection. The unexpected costs of dealing with surgical site infection leads to more cost of treating that patient for that infection, which in turn takes up capacity and resource that could be diverted to treating other patients.

Indeed, according to carefusion.co.uk, healthcare-related costs almost double if a patient suffers a surgical site infection. Conservative estimates suggest that the average cost per infection to the NHS is approximately £3,200; however, some surgical site infections (e.g. those developing after limb amputation) have been estimated to cost the NHS in excess of £6,000 per infection.

The Costs Of Reusable Surgical Instruments Not Related To Surgical Site Infection Or Cross Contamination

Of course, there are costs associated with reusable surgical instruments that have nothing to do with the risk of cross contamination and its consequences. Sterilisation and decontamination of surgical instruments contributes hugely to the lifetime cost of a surgical instrument. Figures suggest that the decontamination of instrument trays can cost anything from £5.32 up to £47.84 while smaller, individual items, such as suction handles, could cost up to £1.38. This is all on top of the actual purchase price.

In addition to the costs noted above, the logistical management of tracking surgical instruments from site to site, along with the associated record keeping required about the instruments’ history and use, is inherently costly. Yes, there are technological solutions to help with that, but these come at a cost and are not foolproof. Lost instruments can cost a 500-bed hospital an average of over £100,000 per year. Problems with instruments are among the 10 most frequent causes of delays to operating theatres. In addition, hospitals can expect surgical tracking systems to cost anything from $15,000 to $120,000 per year.

And then there is wear and tear on instruments as they are repeatedly used. A blade is not going to be as sharp on its 12th use as on its first, and by the same token a reusable instrument is not necessarily going to give its optimum performance for a procedure after multiple uses. One study found that the likelihood of reusable forceps malfunctioning at 11 to 15 uses was 5%, at 16 to 20 uses it was 25%, and at 21 to 25 uses, the chances of the device malfunctioning shot up to 80%. Again, it is hard to calculate the cost and consequences of this, but by using a product that is new and is designed and costed to be used only once, a healthcare practitioner is ensuring that a patient is being treated with a device or instrument that is truly fit for its intended purpose, in addition to all the other sterile benefits previously mentioned in this article.

It is also worth considering the cost of theatre time, when operations are delayed by damaged, missing or dirty reusable instruments. Average theatre costs can vary, and there are no official estimates, but in 2009, the NHS Institute for Innovation and Improvement said that it could be as much as £1,200 per hour.

Conclusion

While it’s hard to establish a concrete like-for-like comparison in costs between reusable and single-use instruments due to the variety of instruments of both types in use, it is clear that reusable medical instruments carry inherent risks and logistical considerations that are not always accounted for within the initial purchase price. Therefore the cost of single-use medical instruments is easier to establish from the outset due to their simple nature and use, and arguably they would work out cheaper on a use-by-use disposable basis than a comparable reusable instrument when the latter is used over a substantial period of time.


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