Less Waste, More Vision

Reducing and properly managing surgical tools and waste could save significant money while reducing environmental impact, two young ophthalmologists report.

In a formal audit of 85 cataract surgeries by multiple surgeons at the University of Ottawa Eye Institute (Canada), Victoria Liu MD found about half of the tools in cataract surgery trays typically went unused. Overall, surgeons used a median of 46% of the tools per surgery, ranging from 32% to 59%. Seven of 22 tools on the tray were used in fewer than 2% of surgeries, with three going entirely unused.

Dr Liu estimated the total cost of these instruments, which did not include phacoemulsification tools, at more than $6,800 Canadian. Removing the eight tools used in less than 10% of surgeries would cut that total by about $2,470. Over just 50 trays, savings on the upfront cost of instruments would exceed $120,000. Even more savings would accrue through reduced handling, sterilisation, and replacement costs. Cataract surgery volume at her centre is about 8,500 cases per year.

An audit of corneal surgery trays for Descemet stripping automated endothelial keratoplasty (DSAEK) produced similar results, Dr Liu reported. A mean of just 32% of 32 tools on the tray was used per surgery, ranging from 22% to 38%, with 41%—or 13 instruments—used in no surgeries at all. The total cost of these 32 instruments is more than $12,000 (€8,234), so eliminating the unused tools for the more than 110 annual DSAEK procedures could save significant money.

However, Dr Liu acknowledged the study samples were small, adding result confirmation and their impact in the OR need evaluation. “We are pending further feedback prior to making corneal tray changes.”

The 5 Rs

Reducing the volume of recyclable or reusable waste disposed of as clinical waste could cut the cost and environmental impact of ophthalmic surgery, said Kar Yen Phoong. Incinerating clinical waste emits four times more carbon dioxide than recycling and costs more than twice as much.

In a study of 24 cataract surgeries and 6 oculoplastic procedures, phacoemulsification cases generated a mean 1.20 kg of clinical waste, of which 0.72 kg—or 60%—was unnecessary. By contrast, major oculoplastic surgeries generated 0.20 kg of clinical waste, with 0.11kg unnecessary, while minor oculoplastic surgeries produced just 0.15 kg of clinical waste, with 0.05 kg unnecessary. The costs of incinerating clinical waste and the amount of carbon dioxide generated were three times higher per cataract case than per major oculoplastic case.

Promoting awareness of recycling, including educating staff on the cost and carbon dioxide emissions of unnecessary clinical waste and placing laminated posters on waste disposal bins in the operating theatre, can also help improve performance, Dr Phoong said. More research to reduce the amount of plastic and other unnecessary disposables used in customised cataract packs is also important, she noted, adding most instruments used in oculoplastic surgery are reusable after sterilisation.

Reuse, reduce, recycle, rethink, and research are the five keys to improvement, Dr Phoong concluded.

“Small steps can make a huge difference.”

Both doctors presented at the 2023 ESCRS Congress in Vienna.

Victoria Liu MD is an ophthalmology resident at the University of Ottawa Eye Institute, Ottawa, Canada.

Kar Yen Phoong MBBS is an ophthalmology resident at East Lancashire Hospitals NHS Trust, Blackburn, UK.