"I led the list for awhile and it was shocking to me," McGuire says. "We are all competitive. No one wants to be an outlier. When it was reviewed that way, it made the problem ugly, and visual."
In particular, the internal review examined the process of "surgeon changed mind," evaluating the reasons behind surgeons' choices, what was accomplished, and the impact on waste flow.
"We are the drivers of the cost, we need to be part of the solution," McGuire says. "Physicians are responsible for ordering a significant amount of material."
A few simple changes amounted to a big impact. Intra-operative waste, which had occurred in 20.2% of procedures prior to the education program, decreased to 10.3% of procedures. Before the awareness program, surgical waste represented 4.2% of the total operative spine budget. Afterward, that percentage decreased to 1.2%.
Overall, the "awareness program was successful in decreasing the cost burden associated with intra-operative waste by 66%," the report states. That was achieved by decreasing the number of implants wasted from 44% to 24% and decreasing the "surgeon changed mind" waste from 42% to 24%. The changes "proved to be and continues to be effective in making surgeons aware of the import of their choices and the costs related to surgical waste," McGuire and his colleagues wrote.
Christopher Kauffman, MD, program co-chair of the NASS annual meeting and orthopedic surgeon at the University Medical Center in Tennessee, said in a statement that the McGuire report should be a "wake-up call" for physicians, particularly spine surgeons.
Looking back, McGuire says it's important that physician leadership, in particular, prompt change. "There has to be an internal champion for medical equipment conservation." he says. "One of the physicians [must] believe that this is the right thing to do."