{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T15:28:31Z","timestamp":1772724511421,"version":"3.50.1"},"reference-count":54,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Waste accounts for up to 25% of United States healthcare expenditures. Many sterilized surgical instruments remain unused during procedures, contributing to this burden. Reducing the quantity of unused surgical instrumentation presents an opportunity to decrease costs while improving operating room efficiency. This study aimed to characterize instrument utilization patterns and implements a novel, systematic, replicable protocol to eliminate excess sterile instrumentation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This prospective, single-center study investigated sterile instrumental utilization rates (IURs) across and within procedures. Craniotomy for tumor was used to characterize instrument utilization patterns on a per-surgeon, per-surgery, and per-instrument level. A novel 3-phase protocol was designed to systematically reduce sterile surgical waste. In phase 1, IURs were calculated by dividing the instruments used during a procedure by the number provided. Instruments used in fewer than 20% of cases were removed in phase 2. Streamlined instrument kits were demoed while the original kit remained at hand, and instruments were replaced as requested. Phase 3 represented full integration of the reduced kits with removal of the original kits. IURs and the number of instruments used were compared before and after protocol implementation. The protocol was implemented in 17 additional surgical procedures. Follow-up data were collected over 1 year after instrument kit reduction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The authors observed 69 cases across 6 procedures. Procedural IURs ranged from 11.3% to 38.4%. Most instrument types remained infrequently used (&lt; 20%) across procedures. In craniotomy for tumor, IUR among the pilot instrument kit ranged from 30.6% to 35.3% (median 33.4%) with no significant variation in the number of instruments used per case (p = 0.88). Following protocol implementation, craniotomy instrument kits were reduced from 157 to 99 instruments. IUR increased to 55.2% (p &lt; 0.001) with no change in the number of instruments used per case (mean 52.2 \u00b1 5.4 preintervention vs 54.4 \u00b1 5.0 postintervention, p = 0.43). The number of infrequently used instruments decreased from 38 to 10. Applied to 18 procedure types across 11 surgical specialties, the protocol reduced kit sizes by 21%\u201360% (median 38%). No changes to reduced instrument kits were requested following implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Instrument utilization is consistent between surgeons and cases. The systematic elimination of unused sterile surgical instrumentation can therefore reduce surgical waste through a replicable protocol without impacting surgeon instrument selection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.8.jns251183","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T12:00:19Z","timestamp":1769083219000},"page":"729-738","source":"Crossref","is-referenced-by-count":0,"title":["Protocol for the systematic reduction of sterile surgical instrument waste: a single-institution prospective implementation and analysis"],"prefix":"10.3171","volume":"144","author":[{"given":"Timothy R.","family":"West","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Massachusetts General Hospital, Boston;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole A.","family":"Perez","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kwaku","family":"Adubofour","sequence":"additional","affiliation":[{"name":"Harvard College, Cambridge, Massachusetts;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mercy H.","family":"Mazurek","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zsombor T.","family":"Gal","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ethan A.","family":"Wetzel","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander F.","family":"Wang","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine, Cleveland, Ohio;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Li","sequence":"additional","affiliation":[{"name":"Harvard T.H. Chan School of Public Health, Boston;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Vangel","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Massachusetts General Hospital, Boston;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wilton C.","family":"Levine","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston;"},{"name":"Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William T.","family":"Curry","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Massachusetts General Hospital, Boston;"},{"name":"Harvard Medical School, Boston;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bryan D.","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Massachusetts General Hospital, Boston;"},{"name":"Harvard Medical School, Boston;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ganesh M.","family":"Shankar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Massachusetts General Hospital, Boston;"},{"name":"Harvard Medical School, Boston;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashley M.","family":"Vieira","sequence":"additional","affiliation":[{"name":"Central Sterile Processing and Supply, Massachusetts General Hospital, Boston; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meaghan","family":"Gray","sequence":"additional","affiliation":[{"name":"Central Sterile Processing and Supply, Massachusetts General Hospital, Boston; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcia","family":"Salvucci","sequence":"additional","affiliation":[{"name":"Central Sterile Processing and Supply, Massachusetts General Hospital, Boston; and"},{"name":"Department of Procedural Services, Massachusetts General Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian V.","family":"Nahed","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Massachusetts General Hospital, Boston;"},{"name":"Harvard Medical School, Boston;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Health Aff (Millwood)","first-page":"6","article-title":"National health care spending in 2022: growth similar to prepandemic rates: national health care spending growth in 2022 similar to prepandemic rates","volume":"43","author":"Hartman M","year":"2024","unstructured":"Hartman M, Martin AB, Whittle L, Catlin A. National health care spending in 2022: growth similar to prepandemic rates: national health care spending growth in 2022 similar to prepandemic rates. Health Aff (Millwood). 2024;43(1):6\u201317."},{"issue":"15","key":"b2","series-title":"JAMA","first-page":"1501","article-title":"Waste in the US health care system: estimated costs and potential for savings","volume":"322","author":"Shrank WH","year":"2019","unstructured":"Shrank WH, Rogstad TL, Parekh N. Waste in the US health care system: estimated costs and potential for savings. JAMA. 2019;322(15):1501\u20131509."},{"issue":"7","key":"b3","series-title":"J Med Syst","first-page":"116","article-title":"Improving operating room efficiency via reduction and standardization of video-assisted thoracoscopic surgery instrumentation","volume":"42","author":"Friend TH","year":"2018","unstructured":"Friend TH, Paula A, Klemm J, Rosa M, Levine W. Improving operating room efficiency via reduction and standardization of video-assisted thoracoscopic surgery instrumentation. J Med Syst. 2018;42(7):116."},{"issue":"2","key":"b4","series-title":"J Biomed Mater Res","first-page":"131","article-title":"Safety and cleaning of medical materials and devices","volume":"53","author":"Merritt K","year":"2000","unstructured":"Merritt K, Hitchins VM, Brown SA. Safety and cleaning of medical materials and devices. J Biomed Mater Res. 2000;53(2):131\u2013136."},{"issue":"2","key":"b5","series-title":"J Neurosurg","first-page":"620","article-title":"Operating room waste: disposable supply utilization in neurosurgical procedures","volume":"126","author":"Zygourakis CC","year":"2017","unstructured":"Zygourakis CC, Yoon S, Valencia V,  Operating room waste: disposable supply utilization in neurosurgical procedures. J Neurosurg. 2017;126(2):620\u2013625."},{"issue":"5 Suppl","key":"b6","series-title":"Am J Infect Control","first-page":"S2","article-title":"Disinfection and sterilization: an overview","volume":"41","author":"Rutala WA","year":"2013","unstructured":"Rutala WA, Weber DJ. Disinfection and sterilization: an overview. Am J Infect Control. 2013;41(5 Suppl):S2\u2013S5."},{"issue":"1","key":"b7","series-title":"World J Surg","first-page":"29","article-title":"Global public health impact of recovered supplies from operating rooms: a critical analysis with national implications","volume":"39","author":"Wan EL","year":"2015","unstructured":"Wan EL, Xie L, Barrett M,  Global public health impact of recovered supplies from operating rooms: a critical analysis with national implications. World J Surg. 2015;39(1):29\u201335."},{"issue":"1","key":"b8","series-title":"Sustainability","first-page":"430","article-title":"Reducing the environmental impact of sterilization packaging for surgical instruments in the operating room: a comparative life cycle assessment of disposable versus reusable systems","volume":"14","author":"Friedericy HJ","year":"2021","unstructured":"Friedericy HJ, Van Egmond CW, Vogtl\u00e4nder JG, Van Der Eijk AC, Jansen FW. Reducing the environmental impact of sterilization packaging for surgical instruments in the operating room: a comparative life cycle assessment of disposable versus reusable systems. Sustainability. 2021;14(1):430."},{"issue":"2","key":"b9","series-title":"Br J Surg","first-page":"200","article-title":"Minimising carbon and financial costs of steam sterilisation and packaging of reusable surgical instruments","volume":"109","author":"Rizan C","year":"2022","unstructured":"Rizan C, Lillywhite R, Reed M, Bhutta MF. Minimising carbon and financial costs of steam sterilisation and packaging of reusable surgical instruments. Br J Surg. 2022;109(2):200\u2013210."},{"issue":"4","key":"b10","series-title":"J Am Coll Surg","first-page":"646","article-title":"Assessing the magnitude and costs of intraoperative inefficiencies attributable to surgical instrument trays","volume":"219","author":"Stockert EW","year":"2014","unstructured":"Stockert EW, Langerman A. Assessing the magnitude and costs of intraoperative inefficiencies attributable to surgical instrument trays. J Am Coll Surg. 2014;219(4):646\u2013655."},{"issue":"1","key":"b11","series-title":"Foot Ankle Orthop","first-page":"24730114241238231","article-title":"Carbon footprint of minor foot and ankle surgery: a randomized controlled trial","volume":"9","author":"Parker EB","year":"2024","unstructured":"Parker EB, Bluman EM, Chiodo CP, Martin EA, Smith JT. Carbon footprint of minor foot and ankle surgery: a randomized controlled trial. Foot Ankle Orthop. 2024;9(1):24730114241238231."},{"issue":"1","key":"b12","series-title":"World J Urol","first-page":"15","article-title":"Environmental impact of current endoscopic technology in urological procedures: a systematic review on reusable vs. disposable scopes","volume":"43","author":"Peyrottes A","year":"2024","unstructured":"Peyrottes A, Long-Depaquit T, Prad\u00e8re B,  Environmental impact of current endoscopic technology in urological procedures: a systematic review on reusable vs. disposable scopes. World J Urol. 2024;43(1):15."},{"issue":"8","key":"b13","series-title":"Plast Reconstr Surg Glob Open","first-page":"e6085","article-title":"Interventions to reduce surgical waste burden: a systematic review","volume":"12","author":"Vu C","year":"2024","unstructured":"Vu C, Ibarra-Vega A, Yang CD,  Interventions to reduce surgical waste burden: a systematic review. Plast Reconstr Surg Glob Open. 2024;12(8):e6085."},{"issue":"3","key":"b14","series-title":"Int Forum Allergy Rhinol","first-page":"239","article-title":"A cradle-to-grave life cycle assessment of the endoscopic sinus surgery considering materials, energy, and waste","volume":"15","author":"Mousania Z","year":"2025","unstructured":"Mousania Z, Kayastha D, Rimmer RA, Atkinson JD. A cradle-to-grave life cycle assessment of the endoscopic sinus surgery considering materials, energy, and waste. Int Forum Allergy Rhinol. 2025;15(3):239\u2013249."},{"issue":"1","key":"b15","series-title":"Anesth Analg","first-page":"220","article-title":"A cost and waste-savings comparison between single-use and reusable pulse oximetry sensors across US operating rooms","volume":"139","author":"Stockert EW","year":"2024","unstructured":"Stockert EW, Carvalho B, Sun EC. A cost and waste-savings comparison between single-use and reusable pulse oximetry sensors across US operating rooms. Anesth Analg. 2024;139(1):220\u2013225."},{"key":"b16","series-title":"US Bureau of Labor Statistics","article-title":"CPI Inflation Calculator","unstructured":"CPI Inflation Calculator. US Bureau of Labor Statistics. Accessed December 11, 2025.www.bls.gov\/data\/inflation_calculator.htm"},{"issue":"6S Suppl 5","key":"b17","series-title":"Ann Plast Surg","first-page":"S635","article-title":"Data analysis of plastic surgery instrument trays yields significant cost savings and efficiency gains","volume":"86","author":"Wood BC","year":"2021","unstructured":"Wood BC, Konchan S, Gay S, Rath S, Deshpande V, Knowles M. Data analysis of plastic surgery instrument trays yields significant cost savings and efficiency gains. Ann Plast Surg. 2021;86(6S Suppl 5):S635\u2013S639."},{"key":"b18","series-title":"J Surg Res","first-page":"320","article-title":"Surgical tray optimization as a simple means to decrease perioperative costs","volume":"220","author":"Farrelly JS","year":"2017","unstructured":"Farrelly JS, Clemons C, Witkins S,  Surgical tray optimization as a simple means to decrease perioperative costs. J Surg Res. 2017;220:320\u2013326."},{"issue":"20","key":"b19","series-title":"Spine (Phila Pa 1976)","first-page":"1714","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 D","year":"2014","unstructured":"Lunardini D, Arington R, Canacari EG, Gamboa K, Wagner K, McGuire KJ. 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. Spine (Phila Pa 1976). 2014;39(20):1714\u20131717."},{"issue":"5","key":"b20","series-title":"J Healthc Qual","first-page":"277","article-title":"Application of lean methodology for improved quality and efficiency in operating room instrument availability","volume":"37","author":"Farrokhi FR","year":"2015","unstructured":"Farrokhi FR, Gunther M, Williams B, Blackmore CC. Application of lean methodology for improved quality and efficiency in operating room instrument availability. J Healthc Qual. 2015;37(5):277\u2013286."},{"issue":"2","key":"b21","series-title":"J Pediatr Urol","first-page":"153.e1","article-title":"Decreasing operating room costs via reduction of surgical instruments","volume":"15","author":"Nast K","year":"2019","unstructured":"Nast K, Swords KA. Decreasing operating room costs via reduction of surgical instruments. J Pediatr Urol. 2019;15(2):153.e1\u2013153.e6."},{"issue":"1","key":"b22","series-title":"J Pediatr Urol","first-page":"20","article-title":"Reduction and standardization of surgical instruments in pediatric inguinal hernia repair","volume":"14","author":"Koyle MA","year":"2018","unstructured":"Koyle MA, AlQarni N, Odeh R,  Reduction and standardization of surgical instruments in pediatric inguinal hernia repair. J Pediatr Urol. 2018;14(1):20\u201324."},{"issue":"5","key":"b23","series-title":"Am J Obstet Gynecol","first-page":"652.e1","article-title":"Costs associated with instrument sterilization in gynecologic surgery","volume":"215","author":"Van Meter MM","year":"2016","unstructured":"Van Meter MM, Adam RA. Costs associated with instrument sterilization in gynecologic surgery. Am J Obstet Gynecol. 2016;215(5):652.e1\u2013652.e5."},{"issue":"3","key":"b24","series-title":"Biom J","first-page":"346","article-title":"Simultaneous inference in general parametric models","volume":"50","author":"Hothorn T","year":"2008","unstructured":"Hothorn T, Bretz F, Westfall P. Simultaneous inference in general parametric models. Biom J. 2008;50(3):346\u2013363."},{"key":"b25","article-title":"R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing","unstructured":"R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing. Accessed September 2, 2025.https:\/\/www.R-project.org\/"},{"key":"b26","series-title":"EPA.gov","article-title":"Greenhouse Gas Emissions from a Typical Passenger Vehicle","unstructured":"Greenhouse Gas Emissions from a Typical Passenger Vehicle. EPA.gov. Accessed December 11, 2025.https:\/\/www.epa.gov\/greenvehicles\/greenhouse-gas-emissions-typical-passenger-vehicle#:~:text=2%20per%20mile.-,What%20is%20the%20average%20annual%20carbon%20dioxide%20(CO2)%20emissions,around%2011%2C500%20miles%20per%20year"},{"issue":"1","key":"b27","series-title":"Clin Orthop Relat Res","first-page":"7","article-title":"How can the environmental impact of orthopaedic surgery be measured and reduced? Using anterior cruciate ligament reconstruction as a test case","volume":"483","author":"Silva de Souza Lima Cano N","year":"2025","unstructured":"Silva de Souza Lima Cano N, Engler ID, Mohammadiziazi R,  How can the environmental impact of orthopaedic surgery be measured and reduced? Using anterior cruciate ligament reconstruction as a test case. Clin Orthop Relat Res. 2025;483(1):7\u201319."},{"issue":"1","key":"b1","series-title":"Health Aff (Millwood)","first-page":"6","article-title":"National health care spending in 2022: growth similar to prepandemic rates: national health care spending growth in 2022 similar to prepandemic rates","volume":"43","author":"Hartman M","year":"2024","unstructured":"Hartman M, Martin AB, Whittle L, Catlin A. National health care spending in 2022: growth similar to prepandemic rates: national health care spending growth in 2022 similar to prepandemic rates. Health Aff (Millwood). 2024;43(1):6\u201317."},{"issue":"15","key":"b2","series-title":"JAMA","first-page":"1501","article-title":"Waste in the US health care system: estimated costs and potential for savings","volume":"322","author":"Shrank WH","year":"2019","unstructured":"Shrank WH, Rogstad TL, Parekh N. Waste in the US health care system: estimated costs and potential for savings. JAMA. 2019;322(15):1501\u20131509."},{"issue":"7","key":"b3","series-title":"J Med Syst","first-page":"116","article-title":"Improving operating room efficiency via reduction and standardization of video-assisted thoracoscopic surgery instrumentation","volume":"42","author":"Friend TH","year":"2018","unstructured":"Friend TH, Paula A, Klemm J, Rosa M, Levine W. Improving operating room efficiency via reduction and standardization of video-assisted thoracoscopic surgery instrumentation. J Med Syst. 2018;42(7):116."},{"issue":"2","key":"b4","series-title":"J Biomed Mater Res","first-page":"131","article-title":"Safety and cleaning of medical materials and devices","volume":"53","author":"Merritt K","year":"2000","unstructured":"Merritt K, Hitchins VM, Brown SA. Safety and cleaning of medical materials and devices. J Biomed Mater Res. 2000;53(2):131\u2013136."},{"issue":"2","key":"b5","series-title":"J Neurosurg","first-page":"620","article-title":"Operating room waste: disposable supply utilization in neurosurgical procedures","volume":"126","author":"Zygourakis CC","year":"2017","unstructured":"Zygourakis CC, Yoon S, Valencia V,  Operating room waste: disposable supply utilization in neurosurgical procedures. J Neurosurg. 2017;126(2):620\u2013625."},{"issue":"5 Suppl","key":"b6","series-title":"Am J Infect Control","first-page":"S2","article-title":"Disinfection and sterilization: an overview","volume":"41","author":"Rutala WA","year":"2013","unstructured":"Rutala WA, Weber DJ. Disinfection and sterilization: an overview. Am J Infect Control. 2013;41(5 Suppl):S2\u2013S5."},{"issue":"1","key":"b7","series-title":"World J Surg","first-page":"29","article-title":"Global public health impact of recovered supplies from operating rooms: a critical analysis with national implications","volume":"39","author":"Wan EL","year":"2015","unstructured":"Wan EL, Xie L, Barrett M,  Global public health impact of recovered supplies from operating rooms: a critical analysis with national implications. World J Surg. 2015;39(1):29\u201335."},{"issue":"1","key":"b8","series-title":"Sustainability","first-page":"430","article-title":"Reducing the environmental impact of sterilization packaging for surgical instruments in the operating room: a comparative life cycle assessment of disposable versus reusable systems","volume":"14","author":"Friedericy HJ","year":"2021","unstructured":"Friedericy HJ, Van Egmond CW, Vogtl\u00e4nder JG, Van Der Eijk AC, Jansen FW. Reducing the environmental impact of sterilization packaging for surgical instruments in the operating room: a comparative life cycle assessment of disposable versus reusable systems. Sustainability. 2021;14(1):430."},{"issue":"2","key":"b9","series-title":"Br J Surg","first-page":"200","article-title":"Minimising carbon and financial costs of steam sterilisation and packaging of reusable surgical instruments","volume":"109","author":"Rizan C","year":"2022","unstructured":"Rizan C, Lillywhite R, Reed M, Bhutta MF. Minimising carbon and financial costs of steam sterilisation and packaging of reusable surgical instruments. Br J Surg. 2022;109(2):200\u2013210."},{"issue":"4","key":"b10","series-title":"J Am Coll Surg","first-page":"646","article-title":"Assessing the magnitude and costs of intraoperative inefficiencies attributable to surgical instrument trays","volume":"219","author":"Stockert EW","year":"2014","unstructured":"Stockert EW, Langerman A. Assessing the magnitude and costs of intraoperative inefficiencies attributable to surgical instrument trays. J Am Coll Surg. 2014;219(4):646\u2013655."},{"issue":"1","key":"b11","series-title":"Foot Ankle Orthop","first-page":"24730114241238231","article-title":"Carbon footprint of minor foot and ankle surgery: a randomized controlled trial","volume":"9","author":"Parker EB","year":"2024","unstructured":"Parker EB, Bluman EM, Chiodo CP, Martin EA, Smith JT. Carbon footprint of minor foot and ankle surgery: a randomized controlled trial. Foot Ankle Orthop. 2024;9(1):24730114241238231."},{"issue":"1","key":"b12","series-title":"World J Urol","first-page":"15","article-title":"Environmental impact of current endoscopic technology in urological procedures: a systematic review on reusable vs. disposable scopes","volume":"43","author":"Peyrottes A","year":"2024","unstructured":"Peyrottes A, Long-Depaquit T, Prad\u00e8re B,  Environmental impact of current endoscopic technology in urological procedures: a systematic review on reusable vs. disposable scopes. World J Urol. 2024;43(1):15."},{"issue":"8","key":"b13","series-title":"Plast Reconstr Surg Glob Open","first-page":"e6085","article-title":"Interventions to reduce surgical waste burden: a systematic review","volume":"12","author":"Vu C","year":"2024","unstructured":"Vu C, Ibarra-Vega A, Yang CD,  Interventions to reduce surgical waste burden: a systematic review. Plast Reconstr Surg Glob Open. 2024;12(8):e6085."},{"issue":"3","key":"b14","series-title":"Int Forum Allergy Rhinol","first-page":"239","article-title":"A cradle-to-grave life cycle assessment of the endoscopic sinus surgery considering materials, energy, and waste","volume":"15","author":"Mousania Z","year":"2025","unstructured":"Mousania Z, Kayastha D, Rimmer RA, Atkinson JD. A cradle-to-grave life cycle assessment of the endoscopic sinus surgery considering materials, energy, and waste. Int Forum Allergy Rhinol. 2025;15(3):239\u2013249."},{"issue":"1","key":"b15","series-title":"Anesth Analg","first-page":"220","article-title":"A cost and waste-savings comparison between single-use and reusable pulse oximetry sensors across US operating rooms","volume":"139","author":"Stockert EW","year":"2024","unstructured":"Stockert EW, Carvalho B, Sun EC. A cost and waste-savings comparison between single-use and reusable pulse oximetry sensors across US operating rooms. Anesth Analg. 2024;139(1):220\u2013225."},{"key":"b16","series-title":"US Bureau of Labor Statistics","article-title":"CPI Inflation Calculator","unstructured":"CPI Inflation Calculator. US Bureau of Labor Statistics. Accessed December 11, 2025.www.bls.gov\/data\/inflation_calculator.htm"},{"issue":"6S Suppl 5","key":"b17","series-title":"Ann Plast Surg","first-page":"S635","article-title":"Data analysis of plastic surgery instrument trays yields significant cost savings and efficiency gains","volume":"86","author":"Wood BC","year":"2021","unstructured":"Wood BC, Konchan S, Gay S, Rath S, Deshpande V, Knowles M. Data analysis of plastic surgery instrument trays yields significant cost savings and efficiency gains. Ann Plast Surg. 2021;86(6S Suppl 5):S635\u2013S639."},{"key":"b18","series-title":"J Surg Res","first-page":"320","article-title":"Surgical tray optimization as a simple means to decrease perioperative costs","volume":"220","author":"Farrelly JS","year":"2017","unstructured":"Farrelly JS, Clemons C, Witkins S,  Surgical tray optimization as a simple means to decrease perioperative costs. J Surg Res. 2017;220:320\u2013326."},{"issue":"20","key":"b19","series-title":"Spine (Phila Pa 1976)","first-page":"1714","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 D","year":"2014","unstructured":"Lunardini D, Arington R, Canacari EG, Gamboa K, Wagner K, McGuire KJ. 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. Spine (Phila Pa 1976). 2014;39(20):1714\u20131717."},{"issue":"5","key":"b20","series-title":"J Healthc Qual","first-page":"277","article-title":"Application of lean methodology for improved quality and efficiency in operating room instrument availability","volume":"37","author":"Farrokhi FR","year":"2015","unstructured":"Farrokhi FR, Gunther M, Williams B, Blackmore CC. Application of lean methodology for improved quality and efficiency in operating room instrument availability. J Healthc Qual. 2015;37(5):277\u2013286."},{"issue":"2","key":"b21","series-title":"J Pediatr Urol","first-page":"153.e1","article-title":"Decreasing operating room costs via reduction of surgical instruments","volume":"15","author":"Nast K","year":"2019","unstructured":"Nast K, Swords KA. Decreasing operating room costs via reduction of surgical instruments. J Pediatr Urol. 2019;15(2):153.e1\u2013153.e6."},{"issue":"1","key":"b22","series-title":"J Pediatr Urol","first-page":"20","article-title":"Reduction and standardization of surgical instruments in pediatric inguinal hernia repair","volume":"14","author":"Koyle MA","year":"2018","unstructured":"Koyle MA, AlQarni N, Odeh R,  Reduction and standardization of surgical instruments in pediatric inguinal hernia repair. J Pediatr Urol. 2018;14(1):20\u201324."},{"issue":"5","key":"b23","series-title":"Am J Obstet Gynecol","first-page":"652.e1","article-title":"Costs associated with instrument sterilization in gynecologic surgery","volume":"215","author":"Van Meter MM","year":"2016","unstructured":"Van Meter MM, Adam RA. Costs associated with instrument sterilization in gynecologic surgery. Am J Obstet Gynecol. 2016;215(5):652.e1\u2013652.e5."},{"issue":"3","key":"b24","series-title":"Biom J","first-page":"346","article-title":"Simultaneous inference in general parametric models","volume":"50","author":"Hothorn T","year":"2008","unstructured":"Hothorn T, Bretz F, Westfall P. Simultaneous inference in general parametric models. Biom J. 2008;50(3):346\u2013363."},{"key":"b25","article-title":"R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing","unstructured":"R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing. Accessed September 2, 2025.https:\/\/www.R-project.org\/"},{"key":"b26","series-title":"EPA.gov","article-title":"Greenhouse Gas Emissions from a Typical Passenger Vehicle","unstructured":"Greenhouse Gas Emissions from a Typical Passenger Vehicle. EPA.gov. Accessed December 11, 2025.https:\/\/www.epa.gov\/greenvehicles\/greenhouse-gas-emissions-typical-passenger-vehicle#:~:text=2%20per%20mile.-,What%20is%20the%20average%20annual%20carbon%20dioxide%20(CO2)%20emissions,around%2011%2C500%20miles%20per%20year"},{"issue":"1","key":"b27","series-title":"Clin Orthop Relat Res","first-page":"7","article-title":"How can the environmental impact of orthopaedic surgery be measured and reduced? Using anterior cruciate ligament reconstruction as a test case","volume":"483","author":"Silva de Souza Lima Cano N","year":"2025","unstructured":"Silva de Souza Lima Cano N, Engler ID, Mohammadiziazi R,  How can the environmental impact of orthopaedic surgery be measured and reduced? Using anterior cruciate ligament reconstruction as a test case. Clin Orthop Relat Res. 2025;483(1):7\u201319."}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/144\/3\/article-p729.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/144\/3\/article-p729.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/144\/3\/article-p729.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T14:28:19Z","timestamp":1772720899000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/144\/3\/article-p729.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,1]]},"references-count":54,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/2025.8.jns251183","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,1]]}}}