Becker's ASC Review

Medacta® International is a world leading manufacturer of orthopedic implants, neurosurgical systems, and instrumentation. Medacta's revolutionary approach and responsible innovation have resulted in standard of care breakthroughs in hip replacement with the AMIS® system and total knee replacement with MyKnee® patient matched technology. Over the last 10 years, Medacta has grown dramatically by taking a different approach and placing value on all aspects of the care experience from design to training to sustainability. Medacta is headquartered in Castel San Pietro, Switzerland, and operates in over 30 countries. To learn more about Medacta International, please visit www.medacta.com or follow @Medacta on Twitter. Efficient OR utilization Assuming an eight-hour OR day, where four cases were scheduled per day, an extra case could have been completed (more than two hours of under-utilized OR time) on 11 percent of the operating days when using Efficiency instruments compared to 0.1 percent of operating days when using reusable instruments. The proportion of days that could accommodate an additional case increased to 29 percemnt and 51 percent for 10- and 12-hour OR days with Efficiency instruments compared to 0.3 percent and 0.6 percent, respectively, for reusable instruments. Similarly, the proportion of operating days where the OR was over-utilized, resulting in staff overtime pay, ranged from 35 to 38 percent for reusable instruments and 0.1 to 0.7 percent for Efficiency instruments. Comparison with published clinical studies In a single-site clinical study, Siegel et al. reported cost savings of $480 to $600 with single-use instruments vs. reusable instruments for TKA, based on measurements of the resource requirements and costs associated with OR turnover and tray sterilization5. They also reported significantly fewer infections with single-use instruments (0.2 percent vs. 3 percent; p=0.006). In close agreement with those results, this modeling study estimated a median cost savings of $522 based on OR turnover and tray sterilization alone. Other studies have emphasized the importance of case turnover in the OR for optimizing productivity and achieving increased case numbers. Through interdisciplinary workflows, Cendan and Good reported reductions in turnover time of 16 minutes, which translated to an additional 0.5 cases per day on average 7 . This finding is also consistent with the modeling results, which demonstrated that an additional case could be scheduled on 51 percent of 12-hour operating days when using Efficiency instruments. Tray sterilization and tray management were the primary areas for cost savings. Studies of single-use instrumentation and patient- specific instrumentation consistently conclude that 4 to 12 fewer trays need to be sterilized compared to traditional, reusable instruments. However, the costs reported in the literature of sterilizing one tray are highly variable (range: $31 to $100 per tray), which can result from operational and staff wage differences between sites. This modeling study suggests that these large variations could substantially impact the potential for cost savings with single-use instruments. The simulated sites that saved the most had tray sterilization costs and staff wages 2 to 3 times greater than those of sites saving the least. The price of the single-use instruments was also not included in the model, but Siegel et al. reported a quote of $490 for another single- use instrument system 5 . In this study, 95 percent of the simulated sites realized cost savings exceeding $500 per case, suggesting that single- use instruments would be cost-effective in the vast majority of cases. Environmental impact Additionally, during the development of the GMK Efficiency platform, Medacta considered the environmental impact of the disposable product's life cycle; from manufacture, to usage, to disposal. An analysis was carried out by SwissClimate, an independent organization focused on assisting companies in setting up holistic climate strategies and sustainable concepts. Their findings demonstrated the environmental impact of GMK Efficiency is neutral, when compared to the average CO2 equivalent annual emission of a hospital using conventional metal re-usable instrumentation. 8 Conclusions GMK Efficiency Single-use instruments can facilitate time and cost savings while bringing greater reliability and predictability to multiple steps in the global delivery of TKA. This modeling study demonstrated that the majority of healthcare providers could realize substantial cost savings, improve OR utilization, and bring predictability to budgeting through less variance in the operating costs. Of the 200 simulated sites, 95 percent saved at least $500 per case and 50 percent saved at least $1,000 per case. Based on an estimated 700,000 TKA cases per year 2 , an average cost savings of $1,003 per case, and a cost of $500 per single-use instrument set, the U.S. healthcare system could realize an annual savings exceeding $350 million with single-use instruments. Efficiency instruments also dramatically reduced overtime in the OR, enabled the opportunity for an increase in the number of daily cases, and may reduce the risk of surgical site infections. Overall, this modeling study suggests that GMK Efficiency Single-use instruments have a compelling potential to help improve the quality and efficiency of delivering TKA procedures.n 2 Kurtz, S., Ong, K., Lau, E. et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89:780-785. 5 Siegel, G. W., Patel, N. N., Milshteyn, M. A. et al. Cost Analysis and Surgical Site Infection Rates in Total Knee Arthroplasty Comparing Traditional vs. Single-Use Instrumentation. J Arthroplasty 2015; 30:2271-2274. 7 Cendan, J. C. & Good, M. Interdisciplinary work flow assessment and redesign decreases operating room turnover time and allows for additional caseload. Arch Surg 2006; 141:65-69; discussion 70. 8 Product Carbon Footprints: Comparative analysis metal vs. single use instrumentation, SwissClimate AG, 2014.

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