Poster Session 12: Health Equity, QI

Introduction:The perioperative sector is recognized to be financially and environmentally demanding, and in the context of rising healthcare costs and anthropogenic climate change, initiatives that emphasize cost reduction, efficiency, and sustainability are increasingly important to achieve the quadruple aim of healthcare.In other surgical specialties, surgical trays are known to be superfluous, with utilization rates of only 14-30%.Multiple institutions have demonstrated that surgical tray reduction can result in financial and environmental savings.This study aimed to determine the utilization rate of instrument trays in frequently conducted urologic reconstructive procedures.Methods: A single-site, observational study was prospectively conducted at a large academic center in Ontario, Canada.Current data ranging from October 2023 to January 2024 was included.Four attending surgeons agreed to participate for intraoperative assessment of tray utilization across six common reconstructive procedures: pelvic organ prolapse repair, urethroplasty, penile prosthesis insertion, artificial urethral sphincter insertion, and both male and female urethral sling surgery.The pick sheets for each surgeon were reviewed and the instrument recipes for all major instrument trays were transcribed into Excel for each procedure.A trained observer (AR) recorded the respective usage of individual instruments from these surgical trays for each respective procedure.Results: Across the six urologic procedure types, 17 procedures were observed.The complete list of procedures and associated instrument trays are noted in Table 1.Depending on the procedure, one or multiple instrument trays were opened, resulting in the opening of 30 surgical trays in total.The total instrument count from the 30 surgical trays was 1418, with an actual intraoperative usage of 251 instruments (17.7%) across all procedures.The highest relative instrument usage per surgical procedure was noted for urethral sling insertion at 20.4%, with the lowest usage noted for pelvic prolapse repair at 16.1%.The highest (31.8%) and lowest (10.0%) instrument usage per tray were observed for the urethroplasty and basic plastics tray, respectively (Figure 1).Conclusions: Instrument tray arrangement in reconstructive urology is an important cost and environmental variable that necessitates regular assessment by the surgical team.Based on our initial results, it would appear that the majority of instruments within a specific surgical tray are unused.Surgical tray optimization represents an opportunity to improve surgical value through reduced costs, increased efficiency, and environmental sustainability.