Vaginal Delivery Surgical Tray Utilization and Cost Savings Analysis
Authors: Henricks Christine , Newbery Gisella , Vircks Julie , Kaufman Eva , Mou Susan , Maulik Devika , Morales Pedro 
Published: July 2024

Introduction: The underutilization of surgical trays increases healthcare costs and strain on sterile processing operations. Other surgical specialties have reported instrument underutilization rates, including a reported rate in gynecology of 20.5% (26.3% in abdominal, 13.6% in vaginal, and 19.4% in laparoscopic surgeries), but data in obstetrics is lacking. The objective of this study is to characterize the instrument utilization rate in vaginal deliveries and to estimate potential cost savings with tray modification. Secondary objectives include determining if utilization correlates with the presence of an obstetric laceration and estimated blood loss (EBL).

Methods: Instrument utilization data was prospectively collected through a data collection form which was completed immediately after vaginal deliveries. The form was completed by a resident physician or an assisting scrub technician immediately following the vaginal delivery at a tertiary care safety net hospital in 2022. The physician team classified perineal lacerations as first, second, third, or fourth-degree. Vaginal or vulvar lacerations without a perineal component were defined as “other.” The EBL from delivery was also determined by the physician team. Descriptive statistics were calculated as well as Mann Whitney U and Spearman’s rank order correlation analyses.

The institutional review board deemed the project to be a quality improvement (#2073102-QI) and patient consent was waived.

Results: The instrument utilization was collected for fifty vaginal deliveries. Each vaginal delivery tray contained 18 instruments. The median vaginal delivery tray instrument utilization rate was 27.7% (IQR 26.4-38.9). A median of only 5.0 instruments (IQR 4.7-7.0) were used per delivery. The most used instruments for all deliveries were Kochers (2), Lister bandage scissors (2), and ring forceps (1). In addition to those 5 instruments, deliveries requiring repair of an obstetric laceration also utilized a straight Mayo scissor and 6-inch Hegar needle holder.

Twenty-one subjects (42.0%) experienced a delivery-related laceration including first-degree laceration (n=3), second-degree laceration (n=11), third-degree laceration (n=2), and other (n=5). There was a significantly higher median number of instruments required when a delivery-related laceration occurred (7.0 versus 5.0 instruments, p<0.001).

There was no correlation between EBL and the number of instruments used in vaginal deliveries (p=0.96). Two deliveries required additional instruments from individually wrapped sterile packages, both of which were right-angle retractors.

Conclusion: This is the first study to characterize instrument utilization rates in an obstetric setting. Only 5 of 18 instruments were used per delivery. This corresponds to an instrument utilization rate of 27.7%, which is higher than what other specialties have reported outside of obstetrics and gynecology (13-26%). Assuming the literature reported costs ranging from $ 0.51 to $3.19 per sterilized instrument, a 33% instrument reduction in the tray would save our institution of 1,700 deliveries between $5,196 - $32,538 per year.

While the study is limited by a small sample size and a convenience sample type which may introduce bias against more complicated cases, lacerations requiring the repair of obstetric anal sphincter injuries (OASIS) were represented in the sample (4%), consistent with larger population studies. Regardless, this study provides baseline data that may motivate a broader assessment of current utilization rates among other institutions that can inform subsequent sterile tray design. This may not only help decrease costs but also address hospital labor shortages concerning sterile processing.

Future studies may utilize larger, multi-institutional cohorts to confirm these preliminary findings of tray underutilization and introduce greater specificity regarding vaginal delivery sterile tray design and cost savings.