Use of a disposable implant system for one-level lumbar fusion surgery had a significantly lower environmental impact compared with a reusable implant system, mainly due to the impact of the steam sterilization process in hospitals and the size of the reusable surgery instrument sets, according to results.
Alexander Leiden and colleagues performed a comparative life cycle assessment to assess the overall environmental impacts of reusable (Viper, Depuy Synthes) and disposable (New Pedicle Screw System, Neo Medical SA) instrumentation and implant sets for one-level lumbar fusion surgery. Researchers conducted power measurements for critical processes, and calculated the cumulative energy demand, abiotic depletion potential, global warming potential, acidification potential and particular matter as selected impact categories. Researchers also used a single score indicator (ReCiPe Endpoint) to aggregate 18 different impact categories contributing to human health, ecosystem quality and resource availability.
In all impact categories, results showed use of the disposable set of instruments had an environmental advantage of approximately 45% to 85% compared with the reusable set, with an overall benefit of 75% identified by the aggregated single-score indicator. Although the production phase of the disposable set generated the main environmental impact when compared with the reusable set, researchers found the major environmental impacts occurred during sterilization of the reusable set due to energy use for washing and steam sterilization.
Sensitivity analysis showed that increasing the number of surgeries per year had a negligible effect on the entire environmental impact. However, researchers found a serious reduction of environmental impacts when the logistics principle was changed from a loaner to consignment system, which divided the number of sterilization cycles into halves. Despite a reduction in the environmental impact with external sterilization, results showed reusable implant sets still had a higher environmental impact vs. the disposable implant set.
“Simple statements for or against reusable products are difficult from an environmental perspective, especially if different design options for these are available,” Leiden told Healio Orthopedics. “In our investigation on a surgery instrument set for spinal fusion surgeries, the steam cleaning and sterilization was a main driver for the environmental impact of surgical instrument. The health care industry should consider the environmental impacts of their products already in the design phase to create surgery instrument systems with a low environmental impact over the whole lifecycle.” – by Casey Tingle
Disclosure: Leiden reports no relevant financial disclosures.