Evidence map›Paper›PMID 40380812›Full record

SynthesisBJS open2025

Reducing surgical instrument usage: systematic review of approaches for tray optimization and its advantages on environmental impact, costs and efficiency.

Myrthe M M Eussen, Esmee Logghe, Stijn Bluiminck, Daan J Comes, Merel L Kimman, Brigitte A B Essers, Lianne M Wellens, Schelto Kruijff, Philip R de Reuver, Nicole D Bouvy

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BJS open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Observational
  3. Article
  4. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Myrthe M M EussenDepartment of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
Esmee LoggheDepartment of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
Stijn BluiminckDepartment of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.ORCID 0009-0004-9676-1206
Daan J ComesDepartment of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Merel L KimmanDepartment of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre, Maastricht, The Netherlands.
Brigitte A B EssersDepartment of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre, Maastricht, The Netherlands.
Lianne M WellensNUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
Schelto KruijffDepartment of Surgery, University Medical Center Groningen, Groningen, The Netherlands.ORCID 0000-0002-5151-7320
Philip R de ReuverDepartment of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Nicole D BouvyDepartment of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.

Funding

CAREFREE projectDutch Research CounsilNWO
6 · The paper itself

Abstract

backgroundOperating rooms generate substantial waste and budget expenditure due to extensive material usage. Reusable instruments are often packaged in trays, which accumulate instruments over time. This review quantifies the advantages of tray optimization (removing redundant instruments), including reduced environmental impact, costs, operating room and processing time.

methodsFollowing PRISMA guidelines, searches were conducted in PubMed, Embase, Web of Science and The Cochrane Library in August 2024 for studies on optimizing surgical trays in human surgeries. Studies were included if they reported on optimization approaches and outcomes related to environmental, economic or efficiency improvements. Exclusions included studies on disposable instruments, animal or veterinary research and patient-specific trays. Risk of bias was assessed using the ROBINS-I (Risk Of Bias In Non-randomised Studies - of Interventions) tool.

resultsThe search identified 4511 studies, with 45 meeting the inclusion criteria. Half of the studies showed a serious risk of bias, while the rest had a moderate risk. Three main optimization strategies were identified, with expert analysis being the most common (n = 29), followed by mathematical modelling. Environmental benefits were reported in all three included studies, although limited in number. Studies reported that 19 to 89% of instruments could be removed from trays, with 31 studies unanimously reporting cost reductions. Additionally, 17 studies demonstrated improved operational efficiency.

conclusionTray optimization strategies effectively reduce resource use, resulting in environmental and economic benefits. Although no standard method exists, effective strategies such as procedure observation and clinician feedback may eliminate over half of the instruments, offering a significant opportunity to minimize resource consumption in the operating room.

Indexed as

Efficiency, OrganizationalEquipment ReuseOperating RoomsSurgical InstrumentsCost-Benefit AnalysisEnvironmentHumans

Identifiers

PMID40380812
PMCPMC12084675

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.