ON THE TABLE With healthcare costs skyrocketing, facilities need to find creative ways to save.

Reposable instruments, which are labeled for a limited number of uses, occupy the middle ground between disposables and reusables. Their limited-use lifespans are cost-effective and eco-friendly choices that won't jeopardize quality surgical outcomes, giving you lower-cost, eco-friendly options for filling your ORs with high-performing tools.

Surgeon-approved
The first reposables hit the market more than a decade ago, says Guy Voeller, MD, FACS, professor of surgery at the University of Tennessee Medical Center in Memphis. Most of the laparoscopic ORs at the medical center house reposable graspers, trocars, scissors and retractors, says Dr. Voeller, who points out some facilities do a better job than others in getting the instruments into regular rotation, mostly because some surgeons are more agreeable than others in using them.

General surgeon Alexander Rosemurgy, MD, director of the Surgical Digestive Disorders and GERD Center at Florida Hospital in Tampa, believes the quality of reposable instruments is more than adequate for multiple uses. The scissors he uses, for example, are always sharp and cut well.

"The clinical performance is how most surgeons judge these instruments," says Dr. Rosemurgy. "That they're used shows they perform well, that they're comparable to conventional options."

Ophthalmologist Richard J. Ruckman, MD, FACS, physician-owner of the Center for Sight in Lufkin, Texas, used diamond paracentesis and trapezoid incision blades for years before transitioning to reposable steel versions approved for 15 uses. In addition, the manufacturer of his phacoemulsification machine labels the unit's phaco tip for 30 uses, and the infusion sleeve and reusable tubing set for 20 uses, lifespans he says each item holds up for very well.

He also doesn't feel a difference in performance between reposable and conventional diamond blades. "Past criticism has mentioned that the blades on reposable knives dull after several uses, but that hasn't been the case in my experience," he says. "It's not a significant factor as long as the blades are used for the suggested amount of cases."

PRECISE CUT Richard Ruckman, MD, FACS, performs cataract surgery with a reposable metal blade.

Not all reposable devices are interchangeable, says Vangie Dennis, RN, BSN, CNOR, CMLSO, administrative director of the Spivey Station Surgery Center in Jonesboro, Ga. She calls modular designs that let surgeons switch out different tips and handles on several types of instruments a "huge advantage" in terms of versatility and ergonomics.

Cost-cutting advantage
The concept of limited-use lifespans is very attractive because healthcare costs are spiraling out of control, says Dr. Rosemurgy. "It really comes down to controlling costs," he continues. "Healthcare professionals need to be focused on the cost of care, because if we don't get interested, someone's going to get very interested for us. And their decisions will be based purely on economic issues that won't consider our clinical needs."

Dr. Voeller agrees. "We all want to save money, and I think that's the main advantage of reposables," he says. "As long as the instrument does what I need it to do, I'm all for it. If it doesn't jeopardize the patient or the procedure, most surgeons are fine with using reposables."

Reposables do in fact offer significant cost-saving opportunities. According to Ms. Dennis, disposable instruments run between $300 and $400 (depending on the manufacturer and brand), reposables cost $400 to $500 and the more durable reusables range from $900 to $1,500. "Considering the normal limited-life cycle of reposables is about 10 uses, purchasing them instead of disposables can potentially save you $4,000," says Ms. Dennis.

The diamond paracentesis and trapezoid incision blades Dr. Ruckman used cost $2,400 and $2,800, respectively, with estimated annual repair costs of $800 to $1,000. Factoring purchase and upkeep expenses into per-case expenses, Dr. Ruckman estimates it costs about $3 to use diamond knives if all goes well, but that price could jump significantly if damage to the delicate blades necessitates costly repairs.

The reposable supplies he uses — phaco tip, infusion sleeve and tubing set — cost approximately $14 per case, which Dr. Ruckman says compares favorably with what he'd pay for disposable versions. Additionally, the reposable metal blades he uses cost about $4.50 per case. It's a little more than the diamond blades, but Dr. Ruckman doesn't have to worry about annual maintenance costs.

Waste not
Ms. Dennis says reposables are greener options — you dispose of fewer items compared with single-use supplies and devices — that also reduce costs related to inventory management and delivery expenses, especially for larger health systems.

Dr. Ruckman runs a small surgery center, but it still "bothers me to generate so much medical waste," he says, referring to the widespread use of disposable supplies because of concerns over cross-contamination. Dr. Ruckman points out that reposables now have a track record of success. Debris might be left on instruments that could contaminate the next eye, but he hasn't seen evidence of it. "We get good results — no high instances of TASS or ophthalmitis," he says. "There's nothing to indicate reposable products create any hazard.

"We've used reposable options for a long time and have a very good track record of success," he adds. "There are pressures to go to the other extreme — to use single-use items for almost everything in surgery."

He continues, "I understand the concerns, because there is a small but definite risk of contamination and infection, but at what point do you have to balance being able to provide the service? Reimbursements are flat, but overhead expenses continue to increase. How do you continue to offer quality surgery and stay in business? At some point it becomes cost-prohibitive."

LIMITED LIFE
Counting Each Use

ON TRACK Scanning barcoded instrument sets monitors how often reposables are used.

Reposables simply aren't made to match the longevity of reusable instruments, especially in electrosurgical devices subject to the constant delivery of high energy that can cause internal damage or insulation failure, says Vangie Dennis, RN, BSN, CNOR, CMLSO, administrative director of the Spivey Station Surgery Center in Jonesboro, Ga.

"The biggest issue when using reposables is to be sure you have a process in place to track uses, so they remain within the manufacturers' labeled amount," she adds.

Some ultrasonic scalpels have tick marks that will deactivate the device after the mandated number of uses, says Ms. Dennis, but most high-risk devices don't have such safeguards in place.

It's labor-intensive and cumbersome to manually track instrument usage, never mind the human element that can render counts inaccurate. Back when Ms. Dennis ran a central sterile department at a large hospital that processed 8,000 cases a month, she installed an electronic documentation station where instruments were prepped and packed.

Her staff scanned bar-coded instruments during reprocessing to track the number of sterilizations, but not necessarily specific uses. However, the tally was close enough to gauge when reposables were approaching the end of their limited lives.

— Daniel Cook