{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T09:36:53Z","timestamp":1768901813894,"version":"3.49.0"},"reference-count":27,"publisher":"Elsevier BV","issue":"6","license":[{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,11,19]],"date-time":"2026-11-19T00:00:00Z","timestamp":1795046400000},"content-version":"am","delay-in-days":383,"URL":"http:\/\/www.elsevier.com\/open-access\/userlicense\/1.0\/"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of Orthopaedic Science"],"published-print":{"date-parts":[[2025,11]]},"DOI":"10.1016\/j.jos.2025.04.011","type":"journal-article","created":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T17:32:11Z","timestamp":1746725531000},"page":"1199-1205","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":1,"title":["Optimizing surgical instrument and implant utilization in orthopedic procedures: A lean methodology approach to cost reduction and efficiency improvement"],"prefix":"10.1016","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4830-4690","authenticated-orcid":false,"given":"Kota","family":"Watanabe","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takuji","family":"Iwamoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Nakayama","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shu","family":"Kobayashi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akihito","family":"Oya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Morio","family":"Matsumoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaya","family":"Nakamura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"78","reference":[{"issue":"1","key":"10.1016\/j.jos.2025.04.011_bib1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5435\/JAAOS-D-17-00709","article-title":"Value-based total hip and knee arthroplasty: a framework for understanding the literature","volume":"27","author":"Schwartz","year":"2019","journal-title":"J Am Acad Orthop Surg"},{"key":"10.1016\/j.jos.2025.04.011_bib2","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1186\/1472-6963-12-73","article-title":"Resource utilization and costs before and after total joint arthroplasty","volume":"12","author":"Bozic","year":"2012","journal-title":"BMC Health Serv Res"},{"issue":"6","key":"10.1016\/j.jos.2025.04.011_bib3","first-page":"1253","article-title":"Cost-utility analyses in orthopaedic surgery","volume":"87","author":"Brauer","year":"2005","journal-title":"J Bone Joint Surg Am"},{"key":"10.1016\/j.jos.2025.04.011_bib4","doi-asserted-by":"crossref","first-page":"1815","DOI":"10.1007\/s11999-014-3964-4","article-title":"Current status of cost utility analyses in total joint arthroplasty: a systematic review","volume":"473","author":"Nwachukwu","year":"2014","journal-title":"Clin Orthop Relat Res"},{"issue":"6","key":"10.1016\/j.jos.2025.04.011_bib5","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1016\/j.arth.2015.12.017","article-title":"Selective early hospital discharge does not increase readmission but unnecessary return to the emergency department is excessive across groups after primary total knee arthroplasty","volume":"31","author":"Rossman","year":"2016","journal-title":"J Arthroplast"},{"issue":"3","key":"10.1016\/j.jos.2025.04.011_bib6","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/S0883-5403(98)90171-1","article-title":"Impact of a clinical pathway and implant standardization on total hip arthroplasty: a clinical and economic study of short-term patient outcome","volume":"13","author":"Healy","year":"1998","journal-title":"J Arthroplast"},{"issue":"5","key":"10.1016\/j.jos.2025.04.011_bib7","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1016\/j.arth.2019.01.029","article-title":"How much does a readmission cost the bundle following primary hip and knee arthroplasty?","volume":"34","author":"Phillips","year":"2019","journal-title":"J Arthroplast"},{"issue":"5","key":"10.1016\/j.jos.2025.04.011_bib8","doi-asserted-by":"crossref","first-page":"1348","DOI":"10.1016\/j.arth.2017.12.015","article-title":"Who goes to inpatient rehabilitation or skilled nursing facilities unexpectedly following total knee arthroplasty?","volume":"33","author":"Rondon","year":"2018","journal-title":"J Arthroplast"},{"issue":"8","key":"10.1016\/j.jos.2025.04.011_bib9","doi-asserted-by":"crossref","first-page":"648","DOI":"10.2106\/JBJS.16.00674","article-title":"Formal physical therapy after total hip arthroplasty is not required: a randomized controlled trial","volume":"99","author":"Austin","year":"2017","journal-title":"J Bone Joint Surg Am"},{"issue":"1","key":"10.1016\/j.jos.2025.04.011_bib10","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1007\/s11999-012-2508-z","article-title":"Determinants of direct medical costs in primary and revision total knee arthroplasty","volume":"471","author":"Maradit Kremers","year":"2013","journal-title":"Clin Orthop Relat Res"},{"key":"10.1016\/j.jos.2025.04.011_bib11","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1016\/j.jamcollsurg.2014.06.019","article-title":"Assessing the magnitude and costs of intraoperative inefficiencies attributable to surgical instrument trays","volume":"219","author":"Stockert","year":"2014","journal-title":"J Am Coll Surg"},{"issue":"9","key":"10.1016\/j.jos.2025.04.011_bib12","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1002\/alr.21181","article-title":"Cost of outpatient endoscopic sinus surgery from the perspective of the Canadian government: a time-driven activity-based costing approach","volume":"3","author":"Au","year":"2013","journal-title":"Int Forum Allergy Rhinol"},{"issue":"1","key":"10.1016\/j.jos.2025.04.011_bib13","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1186\/s40463-014-0046-2","article-title":"Reducing otolaryngology surgical inefficiency via assessment of tray redundancy","volume":"43","author":"Chin","year":"2014","journal-title":"J Otolaryngol Head Neck Surg"},{"issue":"2","key":"10.1016\/j.jos.2025.04.011_bib22","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.jemermed.2007.11.108","article-title":"Application of lean manufacturing techniques in the Emergency Department","volume":"37","author":"Dickson","year":"2009","journal-title":"J Emerg Med"},{"issue":"3","key":"10.1016\/j.jos.2025.04.011_bib14","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1002\/jhm.68","article-title":"Lean health care: what can hospitals learn from a world-class automaker?","volume":"1","author":"Kim","year":"2006","journal-title":"J Hosp Med"},{"issue":"2","key":"10.1016\/j.jos.2025.04.011_bib15","first-page":"23","article-title":"'Lean' approach gives greater efficiency","volume":"68","author":"Call","year":"2014","journal-title":"Health Estate"},{"issue":"5","key":"10.1016\/j.jos.2025.04.011_bib16","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1093\/intqhc\/mzp036","article-title":"Application of lean thinking to health care: issues and observations","volume":"21","author":"Joosten","year":"2009","journal-title":"Int J Qual Health Care"},{"issue":"3","key":"10.1016\/j.jos.2025.04.011_bib17","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1108\/09526861311311418","article-title":"Evaluating lean in healthcare","volume":"26","author":"Burgess","year":"2013","journal-title":"Int J Health Care Qual Assur"},{"issue":"1","key":"10.1016\/j.jos.2025.04.011_bib18","doi-asserted-by":"crossref","first-page":"e47","DOI":"10.1016\/j.ejrad.2010.12.045","article-title":"Applying value stream mapping techniques to eliminate non-value-added waste for the procurement of endovascular stents","volume":"81","author":"Teichgr\u00e4ber","year":"2012","journal-title":"Eur J Radiol"},{"issue":"9","key":"10.1016\/j.jos.2025.04.011_bib19","first-page":"633","article-title":"Toyota production system quality improvement initiative improves perioperative antibiotic therapy","volume":"15","author":"Burkitt","year":"2009","journal-title":"Am J Manag Care"},{"issue":"3","key":"10.1016\/j.jos.2025.04.011_bib20","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1097\/BRS.0000000000001703","article-title":"Reduction of inpatient hospital length of stay in lumbar fusion patients with implementation of an evidence-based clinical care pathway","volume":"42","author":"Bradywood","year":"2017","journal-title":"Spine (Phila Pa 1976)"},{"issue":"3","key":"10.1016\/j.jos.2025.04.011_bib21","first-page":"16","article-title":"Seeking perfection in healthcare. A case study in adopting Toyota Production System methods","volume":"23","author":"Kaplan","year":"2008","journal-title":"Healthc Exec"},{"issue":"12","key":"10.1016\/j.jos.2025.04.011_bib23","doi-asserted-by":"crossref","first-page":"2834","DOI":"10.1016\/j.arth.2019.07.040","article-title":"Optimization of orthopedic surgical instrument trays: lean principles to reduce fixed operating room expenses","volume":"34","author":"Cichos","year":"2019","journal-title":"J Arthroplast"},{"issue":"5","key":"10.1016\/j.jos.2025.04.011_bib24","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1111\/jhq.12053","article-title":"Application of lean methodology for improved quality and efficiency in operating room instrument availability","volume":"37","author":"Farrokhi","year":"2015","journal-title":"J Healthc Qual"},{"issue":"20","key":"10.1016\/j.jos.2025.04.011_bib27","doi-asserted-by":"crossref","first-page":"1714","DOI":"10.1097\/BRS.0000000000000480","article-title":"Lean principles to optimize instrument utilization for spine surgery in an academic medical center: an opportunity to standardize, cut costs, and build a culture of improvement","volume":"39","author":"Lunardini","year":"2014","journal-title":"Spine (Phila Pa 1976)"},{"issue":"6","key":"10.1016\/j.jos.2025.04.011_bib25","doi-asserted-by":"crossref","first-page":"1857","DOI":"10.1016\/j.arth.2021.01.041","article-title":"Minimizing surgical instrument burden increases operating room efficiency and reduces perioperative costs in total joint arthroplasty","volume":"36","author":"Lonner","year":"2021","journal-title":"J Arthroplast"},{"key":"10.1016\/j.jos.2025.04.011_bib28","doi-asserted-by":"crossref","first-page":"2834","DOI":"10.1016\/j.arth.2019.07.040","article-title":"Optimization of orthopedic surgical instrument trays: lean principles to reduce fixed operating room expenses","volume":"34","author":"Cichos","year":"2019","journal-title":"J Arthroplast"}],"container-title":["Journal of Orthopaedic Science"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0949265825001320?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0949265825001320?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T21:36:25Z","timestamp":1763760985000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0949265825001320"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":27,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["S0949265825001320"],"URL":"https:\/\/doi.org\/10.1016\/j.jos.2025.04.011","relation":{},"ISSN":["0949-2658"],"issn-type":[{"value":"0949-2658","type":"print"}],"subject":[],"published":{"date-parts":[[2025,11]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Optimizing surgical instrument and implant utilization in orthopedic procedures: A lean methodology approach to cost reduction and efficiency improvement","name":"articletitle","label":"Article Title"},{"value":"Journal of Orthopaedic Science","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jos.2025.04.011","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}]}}