{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T02:44:30Z","timestamp":1782701070706,"version":"3.54.5"},"reference-count":30,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Heidelberg University Library\u2019s Open Access Publishing Fund"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background: Implant supply strategy in spine surgery affects operative workflow, resource utilization, and packaging-related material use, yet has received limited systematic investigation. This study evaluates single-sterile implants versus multipack implants using a hospital-based Health Technology Assessment (HB-HTA) framework. Methods: A non-randomized, mixed-methods comparative study was conducted at a tertiary academic spine center. Time measurements were recorded during eight posterior fusion procedures (four per supply type; n = 18 single-pack screws, n = 20 multipack screws) across three process steps: implant retrieval, sterile transfer, and instrument preparation. Time measurements were recorded per packaging unit; per-implant comparisons were additionally derived for operational interpretation. Packaging volume, weight, and packaging-related CO2-equivalent estimates were calculated per implant. Standardized questionnaires were distributed to operating-room (OR) nurses (n = 14\/21; 66.7%) and institutional surgeons (n = 11\/11; 100%). Manufacturer-provided descriptive process and cost data were analyzed. Results: Multipack implants were associated with consistently shorter handling times across all measured process steps. Mean retrieval time per packaging unit was 25.4 s (multipack) versus 58.7 s (single-pack); retrieval time was significantly shorter for multipack units on the Mann\u2013Whitney U test (p = 0.004), a result that was robust to supply-related outlier events (p = 0.001 after their post hoc exclusion). Packaging-normalized sterile-transfer burden per implant was reduced by a factor of 4.76. Instrument preparation was faster with multipack systems (15.6 s vs. 25.2 s). Packaging volume per implant was reduced by a factor of 5.6, and packaging weight by a factor of 2. Packaging-related CO2-equivalent estimates were lower for multipack implants (0.017 kg vs. 0.026 kg per implant). Survey responses indicated predominantly positive evaluations of workflow and handling efficiency. A trade-off was identified regarding the potential disposal of unused implants (noted by 73% of institutional surgeons). Manufacturer-provided descriptive data suggested scale effects in packaging and sterilization processes. Conclusions: Under high-volume academic conditions, multipack implants were associated with shorter implant-handling process times, favorable staff perceptions, and reduced packaging-related material burden while introducing trade-offs that require local evaluation. These exploratory findings suggest that the implant supply strategy is an underexplored but potentially relevant dimension of surgical process optimization in spine surgery.<\/jats:p>","DOI":"10.3390\/medicina62071242","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:54:42Z","timestamp":1782694482000},"page":"1242","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multipack Versus Single-Sterile Implant Supply in Spine Surgery: A Hospital-Based Health Technology Assessment"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0311-6095","authenticated-orcid":false,"given":"Frederic","family":"Bludau","sequence":"first","affiliation":[{"name":"Department of Orthopaedic and Trauma Surgery, University Medical Centre Mannheim (UMM), 68167 Mannheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8962-4149","authenticated-orcid":false,"given":"Franz","family":"Dally","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Trauma Surgery, University Medical Centre Mannheim (UMM), 68167 Mannheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Vogel","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Trauma Surgery, University Medical Centre Mannheim (UMM), 68167 Mannheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sascha","family":"Gravius","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Trauma Surgery, University Medical Centre Mannheim (UMM), 68167 Mannheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5473-2958","authenticated-orcid":false,"given":"Joe","family":"Mehanna","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Trauma Surgery, University Medical Centre Mannheim (UMM), 68167 Mannheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viktoria","family":"Salopiata","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Trauma Surgery, University Medical Centre Mannheim (UMM), 68167 Mannheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Fennema","sequence":"additional","affiliation":[{"name":"AMR Advanced Medical Research GmbH, 8078 M\u00e4nnedorf, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0030-9171","authenticated-orcid":false,"given":"Steffen","family":"Schulz","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Trauma Surgery, University Medical Centre Mannheim (UMM), 68167 Mannheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1001\/archsurg.134.9.1011","article-title":"Surgery and ergonomics","volume":"134","author":"Berguer","year":"1999","journal-title":"Arch. 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