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Application study of surgical
instruments information
management system in sports
medicine specialty
Jin Tang
1, Min Zhuang
1*, Ping Lin
1, Zichen Wang
1 & Jinzhong Zhao
2
The management of surgical instruments is related to the safety and eciency of surgical operations,
and a surgical instruments information management system (SIIMS) has been developed. The aim of
the current study is to explore the application value of the SIIMS in sports medicine specialty. A set
of self-developed SIIMS for sports medicine surgeries was applied to the study. The application value
of the SIIMS was veried by comparing the safety and eciency of instrument manipulation before
and after its application, with instrument accidents, instrument repair rate, instrument scrap rate and
instrument use eciency as indicators. Through the application of the SIIMS, the incidence of surgical
instrument accidents decreased from 3.7 times to 1.8 times (P = 0.02), the number of instrument repair
decreased from 7.7 times to 2.9 times (P = 0.00), and the number of scrapped instruments decreased
from 5.1 to 2.3 (P = 0.03), when referred to per thousand operations. Before and after the application
of the SIIMS, the average instrument use eciency was 74.0% ± 3.3% and 88.2% ± 4.4%, respectively,
with statistically signicant dierence (P = 0.00). The application of the SIIMS in sports medicine
specialty is helpful to the ne management of surgical instruments, improve surgical safety and
instrument use eciency.
Keywords Surgical instruments management, Operating room, Information system, Sports medicine
Surgery, especially orthopedic surgery is highly dependent on medical equipment. e management of surgical
instruments and equipment is related to the safety and eciency of surgical operations. e smooth operation
depends on the timely, accurate provision and safe and eective use of surgical instruments. Delayed, inadequate,
or incorrect provision of medical equipment, as well as instrument failure during surgery can cause surgery to be
delayed or impossible1–4. From another point, improper use and handling of medical devices can cause damage
to the equipment, which endangers surgical operations in turn, and results in loss of medical assets.
Sports medicine is a rapidly developing orthopedic specialty, in which various minimally invasive repair
and reconstruction techniques rely on a large number of advanced ne surgical instruments. e reasonable
conguration, operation and safe and eective use of these instruments are of great importance both to clini-
cal practice and to extend their service lives5,6. In recent years, the renement and information management of
hospital medical instrument, especially surgical instrument, is an important development trend7–10. However, to
our knowledge, there is no international study on the application of surgical instruments information manage-
ment system (SIIMS) in sports medicine specialty.
erefore, the purpose of this study is generally to explore the application value of the SIIMS in sports
medicine specialty. Because the application value of the SIIMS manifests in many aspects of the service life of
the surgical instruments, in the current study we focused mainly on its value on the extension of service life of
surgical instrument, from the aspects of instrument accidents, instrument repair rate, instrument scrap rate and
instrument use eciency.
e current study is novel in that it was the rst study to evaluated the application value of SIIMS in sports
medicine specialty, specially form the aspects of the value on the extension of the service lives of the instruments.
OPEN
1The Operating Theater, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University School of Medicine, 600
Yishan Road, Shanghai, China. 2The Department of Sports Medicine, Shanghai Sixth People’s Hospital, Shanghai
Jiao Tong University School of Medicine, Shanghai, China. *email: 18930177370@163.com
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It was also the rst study that revealed that the application of a surgical instrument tracking system may inu-
ence the instrument user’s behavior.
Methods
is was a retrospective analysis of prospective collected research data. From 2015 through 2021, we carried
out a study on the application value of informatization in the precision management of surgical instruments in
sports medicine specialty. e research object of the current study were the surgical instruments in the sports
medicine department of our institution, from the aspects of their service life. e intervening measure was the
application of the SIIMS. is study was not related to experiments on humans and/or the use of human tissue
samples, human information and data. According to the Approaches to Ethical Review of Life Sciences and
Medical Research Involving Humans jointly issued by the Chinese National Health Commission, the Ministry
of Education, the Ministry of Science and Technology and the National Administration of Traditional Chinese
Medicine, there was neither need for ethics approval from the institutional review board of Shanghai Sixth
People’s Hospital nor informed consent from the patients. All methods were carried out in accordance with
relevant guidelines and regulations of the institution regarding the conguration, storage, transportation, use,
maintenance, repair and scrap of medical equipment.
From 2015 through 2017, we collected the basic data of instrument management in the operating room of
sports medicine specialty in Shanghai Sixth People’s Hospital, discussed the crux of instrument management, and
determined the technical indicators and basic design scheme of the SIIMS. In 2018, we developed, preliminarily
veried and improved a soware system (with a soware copyright registration number 2019SR1310456) suit-
able for the information management of surgical instruments in sports medicine specialty. From 2019 to 2021,
this SIIMS was applied, and further veried according to the technical indicators set before the study began.
Our hypothesis is that the application of the SIIMS in sports medicine specialty will increase surgical safety and
improve the eciency of the use of instruments.
e SIIMS is based on the client/server (C/S) architecture design, mainly composed of the server, client
and interface management. e client mainly includes functional modules for the management of instrument
conguration, use, maintenance, and scrap, user management and statistical analysis. e interface manage-
ment denes the interface with the handheld scanning instrument. e establishment of the platform database
is a collection of electronic les of all instruments during their useful life cycle. e system includes functions
such as login authentication, query, statistical report, system extension, exogenous instrument management
and instrument disinfection management. e electronic le of a single instrument in its life cycle is set up and
updated in real time in four modules, namely, the in-conguration state, the in-use state, the in-maintenance
state and the scrapped state. e administrator is responsible for the information input of the corresponding
modules according to the authority given.
In our institution, the disinfection of surgical instruments in sports medicine specialty is mainly completed
on the spot in the operating room, and the disinfection status can be known immediately. In some cases, when
the on-site disinfection is full, some instruments are sent to the central supply room of the hospital for disinfec-
tion. At this time, the disinfection status of these instruments is tracked. In the expanded function of this system,
there is an instrument disinfection management plate, which gives the responsible personnel of the central supply
room the corresponding administrator rights, through the interface management and the scanning gun of the
central supply room, to enter the information of the disinfection and transfer status of this part of the instrument
(acceptance, in disinfection, disinfection completed, transport)11.
e technical means of this study are mainly to compare and analyze the safety and eectiveness of the
instrument use before (2015–2017) and aer (2019–2021) the application of the SIIMS. e specic indicators
include the accident rate of instrument manipulation, the repair rate, the scrap rate, and the use eciency of
the instruments.
Instrument manipulation accident refers to the intraoperative accidental damage during the operation
of related instruments and the need for temporary instruments replacement, such as serious damage to the
arthroscope, fracture of the nucleus pulposus clamp, broken teeth of the free body clamp, broken hook of the
suture hook etc. Instrument repair refers to the repair of faulty instruments to retore their function, such as
poor contact of the camera cable plug, poor contact of the power tool battery case, etc., and instrument failure
caused by improper operation such as mild damage to the arthroscope. Instrument scrap refers to the failure
of the instrument that cannot be resolved by maintenance and its use must be abandoned. Instrument accident
rate, instrument repair rate and instrument scrap rate are based on the statistics of the whole sports medicine
department of our institution and are calculated with the current instruments in use and every 1000 operations
as references, respectively.
Instrument use eciency analysis was conducted by taking the use of arthroscopes as a representative. e
number of operations completed with each arthroscope in the life cycle (use—maintenance—use, until scrapped)
was counted, and the use eciency of up to 1000 operations was set as 100%. Instrument use eciency analysis
was carried out for surgeons who worked full time in 2015 through 2017 and 2019 through 2021. In the sports
medicine department of our institution, each principal surgeon could only use the arthroscope assigned to him,
and the utilization rate was calculated based on the number of operations that the arthroscope had been used
during the time period when each surgeon scrapped the arthroscope. If the surgeon had multiple arthroscopes
scrapped during that time period, the average was calculated based on the use eciency of each scrapped
arthroscope as a representative. If the surgeon had no scrapped arthroscopes during that time period, he was
not included in the statistics.
Statistical analysis was performed on relevant data with suitable conditions (SPSS-22), and P < 0.05 was used
as the standard for statistical signicance. For the enumeration data, ANOVA was carried out, the measurement
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data was tested for normality rst, the data conforming to normal distribution was analyzed by Student t test,
and the data not conforming to normal distribution was analyzed by Chi-square test.
Results
In the two target time periods, the number of surgeons in the sports medicine department of our institution was
11 and 15, respectively, while the average number of surgical nurses in the sports medicine specialty (including
scrub nurses and circulating nurses, who were involved in various manipulations, such as rinsing, drying, pack-
ing and disinfection of the instruments) was 7 and 14, respectively. In both time periods, the number of opera-
tions gradually increased year by year, from 3267 in 2015 to 6682 in 2021. e number of operating instruments
increased from 1333 in 2015 to 1643 in 2021 (Table1).
Before and aer the application of the SIIMS, the number of instrument accidents decreased, with an average
of 13.7 and 11 cases per year, respectively (P = 0.0.32). e proportion of instrument accidents in the total oper-
ating instruments decreased to 10.1‰ and 6.7‰ respectively (P = 0.09). e incidence of instrument accidents
per 1000 operations was signicantly reduced, from an average of 3.7 to an average of 1.8 (P = 0.02) (Table2).
Before and aer the application of the SIIMS, the number of instrument repair decreased signicantly, from
an average of 28.3 to an average of 17.7 times per year, respectively (P = 0.01). e proportion of repaired instru-
ment to the total operating instrument decreased, from an average of 17.4‰ to an average of 11.9‰ (P = 0.05).
e number of instrument repair referred to 1000 operations decreased signicantly, from an average of 7.7 to
an average of 2.9 times (P = 0.00) (Table3).
Before and aer the application of the SIIMS, the annual number of scrapped instruments decreased from
an average of 19 to an average of 14.3 pieces per year (P = 0.22). e proportion of scrapped instruments in total
operating instruments decreased from 13.9‰ to 9.8‰ (P = 0.17). e number of scrapped instruments per 1000
operations decreased signicantly, from an average of 5.1 to an average of 2.3 (P = 0.03) (Table4).
Before the application of the SIIMS, the average instrument use eciency was 74.0% ± 3.3% (n = 7). Aer the
application of the SIIMS, the average instrument use eciency was 88.2% ± 4.4% (n = 9). e increase of instru-
ment use eciency was statistically signicant (P = 0.00).
Discussion
is study shows that the application of SIIMS in sports medicine specialty can signicantly reduce the incidence
of surgical instrument manipulation accidents, reduce the rate of surgical instrument repair and scrap per thou-
sand operations, and increase the eciency of surgical instruments.
Table 1. Composition of medical care, amount of operation and number of operating instruments before and
aer the application of the SIIMS.
Pre-application Post-application
2015 2016 2017 2019 2020 2021
Surgeons 11 11 11 15 15 15
Specialist nurses 6 7 8 13 14 15
Amount of surgery 3267 3583 4154 5639 5872 6682
No. of running instruments 1333 1364 1396 1475 1530 1643
Table 2. e incidence of instrument accidents before and aer the application of the SIIMS.
Pre-application
Mean
Post-application
Mean P-value2015 2016 2017 2019 2020 2021
Absolute value 11 17 13 13.7 10 9 14 11 0.32
‰ 8.2 12.5 9.5 10.1 5.7 5.9 8.5 6.7 0.09
Referred to per thousand surgeries 3.4 4.7 3.1 3.7 1.8 1.5 2.1 1.8 0.02
Table 3. Incidence of instrument repair before and aer the application of the SIIMS.
Pre-application
Mean
Post-application
Mean P-value2015 2016 2017 2019 2020 2021
Absolute value 25 27 33 28.3 16 18 19 17.7 0.01
‰ 18.8 19.8 13.6 17.4 10.8 11.8 13.0 11.9 0.05
Referred to per thousand surgeries 7.7 7.5 7.9 7.7 2.8 3.1 2.8 2.9 0.00
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e sports medicine specialty surgery is characterized by minimally invasive arthroscopic surgery, and the
surgical instruments are mainly arthroscopes and endoscopic operating instruments. As an observation instru-
ment, the arthroscope is easily damaged by mechanical impact, friction or scalding. e instruments operated
under arthroscope are mainly thin instruments and open instruments, which are more likely to be damaged
theoretically. Such damage may be caused by improper operation during the operation, or by accidents during
cleaning, packing and disinfection. In general, the rst reason for the loss of sports medicine instrument is natural
aging, which leads to poor contact of camera cable plug, optical cable transmittance loss, poor contact of power
tool battery box, blunt mouth of basket forceps, and closure barrier of suture retriever and etc. Another part of
the reason is mainly related to improper operation, which leads to arthroscope damage, suture passing hook
breakage, nucleus pulposus clamp breakage, free body clamp breakage and so on. Sports medicine surgeons and
operating room nurses are the main operators of the instruments.
e purpose of the development and application of the SIIMS is the ne management of medical instru-
ments, in order to use the SIIMS to increase the eciency of medical instrument conguration, promote the
standardization of the use of medical instruments, strengthen the responsibility of protection and maintenance,
improve the eciency and quality of maintenance. erefore, we have developed evaluation indicators for the
dierent associated objects in the stage of instrument conguration, use and maintenance. In the instrument
use stage, it is mainly to clarify the management objectives of instrument use and maintenance personnel and
implement the responsibility. All relevant personnel will be reminded that the instrument conguration, use and
maintenance status will be counted and associated with individuals. is is a reminder of responsibility, and no
disciplinary action is required. In this study, the safety and eciency of instruments that require repeated use
were mainly evaluated.
However, this study found that, on the whole, the use of sports medicine instrument was relatively safe, and its
use eciency was quite high. In this study, before and aer the application of the SIIMS, the incidence of instru-
ment accidents in every 1000 operations was only 3.7 and 1.8 times respectively, the average number of surgical
instrument maintenance was only 7.7 and 2.9 times, and the average number of instrument scrap was only 5.1
and 2.3. Each arthroscopic arthroscope could be used for an average of 740 and 882 operations before and aer
the application of the SIIMS. However, the pursuit of surgical safety and instrument eciency should never end.
e results of this study are very interesting. Although the SIIMS is not linked to rewards and punishments,
it does serve as a reminder for instrument manipulation personnel to pay attention to the safety and to increase
the eciency of instrument use. e SIIMS seems to make the relevant personnel aware of the responsibility and
obligation to protect the instrument when manipulating them. In fact, the SIIMS also brings benets in terms of
instrument conguration management and maintenance, just outside the focus of this study.
e information management of medical instruments is an important part12–16 of modern hospital manage-
ment. e information management of surgical instruments in sports medicine specialty is conducive to each
functional department’s understanding and control of the application status of specialized instruments and
equipment, is benecial to the reasonable allocation and ecient and safe use of instrument and equipment
and can bring benets to the overall precision and modern management of sports medicine operating room.
Whether this system can be popularized and applied in the management of surgical instruments in other special-
ties remains to be further discussed17,18.
ere are some limitations in this study. First of all, the instruments used in the second phase were not brand
new, and most of them were used in the rst phase. e safety indicators, the repair and scrap rates, and use
eciency of the instruments used in the second phase were actually related to the rst phase, and the indicators
of the rst phase were related to the use status of the instruments before the study began. eoretically, in terms
of the evaluation of the use of the instrument, it is possible to avoid these interferences by evaluating only the
newly congured instruments. However, because the number of newly added instruments is not large in the
target periods of the study, it would have been dicult to carry out relevant research, so all the instruments in use
were used as the study object. In addition, the improvement of instrument safety and eciency may be related
to the improvement of instrument use prociency. In the period aer the application of the SIIMS, surgeons
might have more experience in using the instrument than before the application of the SIIMS. However, there
was no signicant change in the eciency and safety of instrument use during each time period, suggesting that
improvement in prociency was not the most important associated factor.
Conclusion
e application of the surgical instrument information management system in sports medicine specialty is
helpful to the ne management of surgical instruments, improve surgical safety and instrument use eciency.
Table 4. Scrap rate of instruments before and aer the application of the SIIMS.
Pre-application
Mean
Post-application
Mean P-value2015 2016 2017 2019 2020 2021
Absolute value 14 24 19 19 12 14 17 14.3 0.22
‰ 10.5 17.6 13.6 13.9 8.1 9.2 11.6 9.8 0.17
Per thousand procedures 3.9 6.7 4.6 5.1 2.1 2.4 2.5 2.3 0.03
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Data availability
e datasets used the current study are available from the corresponding author (J.T.) on reasonable request.
Received: 29 September 2023; Accepted: 11 March 2024
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Author contributions
J.T.: Conceptualization, Methodology, Investigation, Analysis, Validation, Writing-Original dra. M.Z.: Supervi-
sion. P.L.: Supervision. Z.W.: Analysis and Validation. J.Z.: Supervision, Writing- Reviewing, Editing. All authors
contributed to the article and approved the nal manuscript.
Funding
is work was funded by Shanghai Science and Technology Commission, China, 17411966400.
Competing interests
e authors declare no competing interests.
Additional information
Correspondence and requests for materials should be addressed to M.Z.
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