Minimal Custom Pack Design and Wide-Awake Hand Surgery: Reducing Waste and Spending in the Orthopedic Operating Room

Cassandra L. Thiel, Rafaela Fiorin Carvalho, Lindsay Hess, Joelle Tighe, Vincent Laurence, Melissa M. Bilec, Mark Baratz

Research output: Contribution to journalArticlepeer-review


Background: The US health care sector has substantial financial and environmental footprints. As literature continues to study the differences between wide-awake hand surgery (WAHS) and the more traditional hand surgery with sedation & local anesthesia, we sought to explore the opportunities to enhance the sustainability of WAHS through analysis of the respective costs and waste generation of the 2 techniques. Methods: We created a “minimal” custom pack of disposable surgical supplies expressly for small hand surgery procedures and then measured the waste from 178 small hand surgeries performed using either the “minimal pack” or the “standard pack,” depending on physician pack choice. Patients were also asked to complete a postoperative survey on their experience. Data were analyzed using 1- and 2-way ANOVAs, 2-sample t tests, and Fisher exact tests. Results: As expected, WAHS with the minimal pack produced 0.3 kg (13%) less waste and cost $125 (55%) less in supplies per case than sedation & local with the standard pack. Pack size was found to be the driving factor in waste generation. Patients who underwent WAHS reported slightly greater pain and anxiety levels during their surgery, but also reported greater satisfaction with their anesthetic choice, which could be tied to the enthusiasm of the physician performing WAHS. Conclusions: Surgical waste and spending can be reduced by minimizing the materials brought into the operating room in disposable packs. WAHS, as a nascent technique, may provide an opportunity to drive sustainability by paring back what is considered necessary in these packs. Moreover, despite some initial anxiety, many patients report greater satisfaction with WAHS. All told, our study suggests a potentially broader role for WAHS, with its concomitant emphases on patient satisfaction and the efficient use of time and resources.

Original languageEnglish (US)
Pages (from-to)271-276
Number of pages6
Issue number2
StatePublished - Mar 1 2019


  • anesthesia
  • costs
  • preferences
  • surgery
  • sustainability
  • trash
  • waste
  • wide-awake

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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