SureKits
What is it worth to know what was used in surgery?
We gathered what the scientific literature has already measured about RFID on surgical instruments, what is still a projection, and a calculator so you can run the numbers for your own hospital.
Before the numbers: what each number means
Mixing measured results with estimates is the fastest way to promise what cannot be delivered. So we sort every figure into four categories and always say which one it is.
Observed
Time, read rate or instrument counts recorded directly in a test or in operation.
Implemented and measured
A change that actually happened to the kit, the time or the reprocessing volume after rollout.
Estimated
A financial value, payback or avoided cost from a model. It does not prove the money stopped leaving the budget.
Proposed
A calculated kit configuration that has not been rolled out or validated over time.
We also keep what was shown with RFID apart from kit-rationalization studies done without RFID. The benefit of the latter cannot be credited automatically to the technology.
Where the gains come from
Knowing, instrument by instrument, what went into the room and what was really used opens four fronts of gain. Each has a different kind of evidence.
1. Faster checking
RFID reading cuts the time of item-by-item counting. The manual count in the protocol stays until the hospital validates a change.
2. Assembly with checking
The system points out what is missing or extra in the box during assembly, before it goes to the room.
3. Telling used from unused
At the end of surgery, the scrub nurse or nurse separates what was actually used from what was not, and the count is made with the collector in two steps. Over dozens of procedures it builds a true picture of how each kit is used.
4. Right-sized kits (rightsizing)
Instruments that are almost never used leave the standard kit and are supplied in individual packages, only when the surgeon needs them. The box gets smaller, is reprocessed with fewer pieces and needs fewer purchases.
Rightsizing holds the biggest financial potential, and it is also where clinical care matters most: every withdrawal is reviewed and approved by surgeons and the sterile processing team.
The size of the financial opportunity
These studies reduced, or proposed reducing, kits and calculated the cost impact. Almost every value is an estimate and none used RFID to obtain the saving. They show the size of the opportunity, not the return of a technology. The hospitals and universities cited are the authors of the studies, not Identhis clients.
- US$ 233kadding resterilization per year and avoided purchases, plastic surgeryEstimated
- −62.5%of the instruments in a vascular kitImplemented
- −80.7%in the hand surgery kitProjected
| Study | Change | Value and nature | Ref. |
|---|---|---|---|
| UNC Rex, plastic surgery, 183 casesUS$ 233kresterilization/yr + purchases, estimated | 45.1% withdrawn from one kit (71 pieces) and 36.7% from another (109); 2,652 physical instruments withdrawn | US$ 69,441/year in resterilization and US$ 163,800 in avoided purchases, estimated | [11] |
| UNC Rex, vascular surgery, 168 casesUS$ 195kresterilization/yr + purchases, estimated | 45.8% and 62.5% withdrawn from two kits; 1,255 physical instruments; table setup from 7:44 to 5:02 and from 8:53 to 4:56 | US$ 97,444/year in resterilization and US$ 97,781 in avoided purchases, estimated | [12] |
| Brigham and Women’s, 2026US$ 153kcalculated over 6 months | 29 configurations cut to 12; 11,627 instrument reprocessings avoided in six months | US$ 153,089 calculated (operating room and sterile processing); estimated payback of 5.3 months, in a project without RFID | [16] |
| Canada, orthopedics, 80 proceduresUS$ 34k/yrprojected | A model proposed 47 instruments instead of 88 (−47%) | US$ 34,440/year, projected | [13] |
| Hand surgery, 19 proceduresUS$ 14k/yrprojected | Average 120.1 items opened and 12.6 used; theoretical kit of 23.2 pieces | US$ 13,603/year and −80.7%, projected | [14] |
| Netherlands, 162 surgeries−55%cost per use, modeled | 94-piece kit; optimization suggested −54% in size and weight | −55% cost per use, modeled | [15] |
- Sorted from the largest to the smallest estimated value; the Brigham value covers six months; the Dutch study, which gives only a percentage, comes last.
- The US$ 153,089 adds operating-room and sterile-processing costs. It is not a full sterilization saving nor an RFID return.
What has already been measured with RFID
These results come from studies that used RFID on surgical instruments. Each line holds for that study’s setup, not for every hospital.
- −74%in the time to count 98 instruments, in a simulated scenarioObserved
- −51%in the instruments supplied with kitsImplemented and measured
- −50%in the assembly time of a setImplemented and measured
| Area | Documented result | Nature | Ref. |
|---|---|---|---|
| Counting, 75 and 98 instruments−74%counting time | Manual 130.0 s versus RFID 53.5 s; manual 263.3 s versus RFID 67.5 s, in simulated scenarios | Observed | [1] |
| Counting, 41 instruments−66%reading vs. barcode | RFID 64.0 s versus barcode 190.4 s, with an experienced team | Observed | [2] |
| Rightsizing, Duke (extended)−51%kit supply | Average 50.8% reduction of supply in breast and orthopedic kits; breast surgery setup from 23 to 17 minutes | Implemented and measured | [8] |
| Laparotomy set assembly−50%assembly time | From 20 to 10 minutes; main set utilization from 50% to 66% | Implemented and measured | [4] |
| Rightsizing, Duke (breast)−40%instruments in the kit | 25 of 62 instruments withdrawn (40.3%); none of the 25 was requested in the next 10 surgeries | Implemented and measured | [7] |
| Counting, about 130 items−29%counting time | From 7 to 5 minutes in a Japanese hospital | Operational report | [3] |
| Box assembly0 errorsin 94 assemblies | 94 assemblies in 27 months with no assembly error observed | Observed | [5] |
| Intraoperative use95%single-pass detection | Detection of 95% in a single pass and 100% cumulative over the procedure, in 15 patients, with electrocautery interference reported. It is not the same as a complete read on every pass. | Observed | [6] |
| Real use and agreementκ 0.82agreement | Agreement κ = 0.82 with human observation in 15 breast surgeries | Observed | [7] |
- Sorted from the largest to the smallest percentage gain; rows with no gain percentage come last.
- In the 125-instrument trial, a full count happened in 2 of 4 tests; in the other two, 124 of 125 were detected. That is why we do not claim 100% reading in every test.
- The two Duke papers belong to the same program and may share cases. They are not independent validations.
- The absence of assembly errors is a concrete data point, but it does not measure a reduction against a control group.
What is known in Brazil
There is relevant Brazilian work on instrument rationalization. It confirms the opportunity, but none of it shows the added gain from RFID.
| Publication | Observed or estimated data | What cannot be concluded | Ref. |
|---|---|---|---|
| University hospital in southern Brazil, ophthalmology, 2020R$ 420kavoidable purchases, estimated | −13.10% of items per tray; annual surgical output +17.88%; R$ 420 thousand in avoidable purchases, estimated | The output increase also depended on scheduling and capacity; it is not an isolated RFID effect | [18] |
| Porto Alegre (HCPA), 2018−10.9%pieces per tray, observed | Observed average reduction of 10.92% of pieces per tray | It did not use RFID and did not calculate a technology ROI | [17] |
| Santo André (SP), orthopedics, 2023R$ 34kestimated waste | 854 consigned boxes processed and unused after 85 canceled surgeries; estimated waste of R$ 34,340.18 | It does not equal 854 kits saved with RFID nor a price per instrument | [19] |
- R$ 34,340.18 divided by 854 boxes gives about R$ 40.21 per box. It is an average of the waste studied, not a cost per instrument nor a price list. The same study cites R$ 19.11 per processed costing object, computed by absorption, which is not a marginal cost per instrument either.
- That is why the calculator below carries no reference prices. The reprocessing cost is your hospital’s own.
What it costs to reprocess one instrument in Brazil
To work out the return of any solution that reduces reprocessing, you need a cost per instrument and per cycle. There is no proven national value. We gathered the values that appear in six Brazilian costing references. They range from R$ 0.29 to R$ 8.18, because they measure different things.
| Source | Unit cost | What the value includes |
|---|---|---|
| Public contracts, 2024 to 2026 | R$ 8.18 | Median per contract unit of a sterilization service. The contract unit is not always a single piece |
| State of Rondônia government, 2023 | R$ 6.34 | Estimated reference per instrument, used in contracting plans |
| Souza et al., Rev Eletr Enferm, 2015, cited by Lopes and Poveda (2023) [19] [23] | R$ 6.05 | Sterilization cost per item, according to the methodology cited |
| Same study [19] [23] | R$ 5.33 | Per product processed in the CME, of any type |
| Paula et al., Revista SOBECC, 2015 [24] | R$ 0.29 | Per instrument, with the autoclave and labor share, but not the full CME cost |
Full cost
Cleaning, inspection, assembly, packaging, sterilization, labor and allocated overhead. It is the value of the whole activity of reprocessing, and the preliminary reference we use is R$ 6.34 per instrument per cycle.
Realizable saving
Only the costs that stop existing when the instrument leaves the kit. If a kit goes from 80 to 60 instruments, the hospital still uses the autoclave and many CME resources. You cannot count 20 × R$ 6.34 as a saving.
Where the saving usually is
In the 2023 Brazilian study on orthopedic boxes, the inspection and preparation step took the most working time (for example, 103 of 218 minutes for hip boxes). That is why the labor saved needs to be measured.
Use R$ 6.34 as the reference full cost, but work out your hospital’s avoidable marginal cost before presenting the return as a proven saving.
- The historical values were not adjusted for inflation, and R$ 6.34 is from 2023.
- The values come from a review of six costing references. They are not a statistically proven national average, but they serve as a starting parameter for feasibility studies.
- In the calculator below, the full cost is an editable reference, and the part that really stops existing is a separate field. That part’s starting value is 30%, in line with studies. Measure yours in the CME.
Run the numbers for your hospital
The calculator follows the evidence report’s method: it starts from physical quantities (instruments withdrawn, reprocessings per year) and only then applies the hospital’s real variable cost. The fields come filled with example values, only to show how the calculation works. They are not market data. Replace them all with your own.
Your data never leaves your browser.
What is still not proven
Saying this plainly is what makes the rest credible.
Clinical outcomes
No robust study credits individual-instrument RFID with fewer surgical site infections, deaths, retained items or canceled surgeries.
Losses and breakage
There is also no showing of a causal reduction in asset losses, repairs or breakage. Per-instrument history lets lifespan be studied, but it does not prove alerts reduced breakage.
Rationalization payback
The payback from trimming trays without RFID is not the payback of tags, readers and software. The two Duke papers also do not add up as independent samples.
Different technology, different result
Several studies use high-frequency RFID (13.56 MHz). A UHF architecture, like SureKits, needs its own validation of reading, nearby metal and sterilization.
Mandatory counting
AORN treats RFID as an aid to counting. None of the studies justifies dropping the manual count from the protocol without hospital validation and approval.
Brazilian regulation
RDC 15/2012 covers traceability of sterilization batches. It does not require individual RFID on each instrument.
The right reading: published numbers show feasibility and potential. They do not replace a local assessment, which is why we suggest a pilot with agreed indicators first.
How to validate it at your hospital
A well-designed pilot separates three results and never counts the same hour of work twice.
1. Reading performance
Checking time and accuracy, with the same kit types and the same team, including exceptions and rework.
2. Measured operating saving
Instruments withdrawn after clinical approval, requests for withdrawn pieces in later cases and reprocessings avoided, comparing before and after.
3. Net financial benefit
Reconciling variable cost, truly capturable hours, avoided purchases, investment and recurring cost.
References
The numbers in the tables point to this list. Links lead to the original publication’s page and some require a subscription. References 20 and 21 are regulatory and professional, and 22 is a review, not an intervention study.
- Hendricks W, Mecca J, Rahimi M, et al. Evaluation of a Novel System for RFID Intraoperative Cardiovascular Analytics. IEEE J Transl Eng Health Med. 2022;10:1900309. doi.org/10.1109/JTEHM.2022.3196832
- Kusuda K, Yamashita K, Morishita E, et al. Comparison of Reading Times of RFID-Tagged and Barcode-Engraved Surgical Instruments. J Surg Res. 2024;304:121-125. doi.org/10.1016/j.jss.2024.09.087
- Hanada E, Hayashi M, Ohira A. Introduction of an RFID Tag System to a Large Hospital and the Practical Usage of the Data Obtained. ISMICT. 2015. doi.org/10.1109/ISMICT.2015.7107508
- Hanada E, Ohira A, Hayashi M, Sawa T. Improving Efficiency through Analysis of Data Obtained from an RFID Tag System for Surgical Instruments. IEEE ICCE-Berlin. 2015. doi.org/10.1109/ICCE-Berlin.2015.7391339
- Kusuda K, Yamashita K, Ohnishi A, et al. Management of Surgical Instruments with Radio Frequency Identification Tags. Int J Health Care Qual Assur. 2016;29(2):236-247. doi.org/10.1108/IJHCQA-03-2015-0034
- Yamashita K, Kusuda K, Ito Y, et al. Evaluation of Surgical Instruments With Radiofrequency Identification Tags in the Operating Room. Surg Innov. 2018;25(4):374-379. doi.org/10.1177/1553350618772771
- Olivere LA, Hill IT, Thomas SM, Codd PJ, Rosenberger LH. Radiofrequency Identification Track for Tray Optimization: An Instrument Utilization Pilot Study in Surgical Oncology. J Surg Res. 2021;264:490-498. doi.org/10.1016/j.jss.2021.02.049
- Hill I, Olivere L, Helmkamp J, et al. Measuring Intraoperative Surgical Instrument Use with Radio-Frequency Identification. JAMIA Open. 2022;5(1):ooac003. doi.org/10.1093/jamiaopen/ooac003
- Yoshikawa T, Kimura E, Akama E, et al. Prediction of the Service Life of Surgical Instruments from the Surgical Instrument Management System Log Using Radio Frequency Identification. BMC Health Serv Res. 2019;19:695. doi.org/10.1186/s12913-019-4540-0
- Yamashita K, Miyabe S, Yamashita T, et al. Corrosion Generation and Cleaning Effect on Surgical Instruments with Attached Radiofrequency Identification Tags in Long-Term Usage. Surg Infect. 2019;20(8):665-671. doi.org/10.1089/sur.2019.034
- 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-S639. doi.org/10.1097/SAP.0000000000002913
- Knowles M, Gay SS, Konchan SK, et al. Data Analysis of Vascular Surgery Instrument Trays Yielded Large Cost and Efficiency Savings. J Vasc Surg. 2021;73(6):2144-2153. doi.org/10.1016/j.jvs.2020.09.043
- Toor J, Bhangu A, Wolfstadt J, et al. Optimizing the Surgical Instrument Tray to Immediately Increase Efficiency and Lower Costs in the Operating Room. Can J Surg. 2022;65(2):E275-E281. doi.org/10.1503/cjs.022720
- Onuh OC, Cassidy MF, Tran DL, et al. Utilization Fraction of Ambulatory Hand Procedures: Cost-Reduction Through Surgical Instrument Tray Optimization. HAND. 2026;21(2):292-299. doi.org/10.1177/15589447241288255
- Eussen MMM, Brandwijk RM, Reising RC, et al. Surgical Tray Optimization: A Prospective and Survey-Based Evaluation of Environmental and Economic Outcomes. Surg Endosc. 2026;40:3080-3089. doi.org/10.1007/s00464-025-12499-2
- Hyland CJ, Etheridge JC, Newell PC, Yates EF, Talbot SG. The Financial and Environmental Impacts of Optimizing Surgical Instrument Trays in Plastic Surgery. Plast Reconstr Surg. 2026;157(4):644e-647e. doi.org/10.1097/PRS.0000000000012444
- Schneider DSS, Anzanello MJ, Pirovano RSV, Fogliatto FS. Sistemática para racionalização de instrumentais de bandejas cirúrgicas. Rev SOBECC. 2018. doi.org/10.5327/Z1414-4425201800010009
- Schneider DSS, Magalhães AMM, Glanzner CH, et al. Gerenciamento de instrumentais oftalmológicos e otimização de processos: estudo de método misto. Rev Gaúcha Enferm. 2020;41:e20190111. doi.org/10.1590/1983-1447.2020.20190111
- Lopes SG, Poveda VB. Proposta de modelo para cálculo de desperdício associado ao processamento de instrumentais cirúrgicos consignados. Rev Latino-Am Enfermagem. 2023;31. doi.org/10.1590/1518-8345.6716.4062
- Anvisa. Resolução RDC nº 15, de 15 de março de 2012, arts. 24 a 26. anvisalegis.datalegis.net
- Cochran K. Guidelines in Practice: Prevention of Unintentionally Retained Surgical Items. AORN J. 2022;116(5):427-440. doi.org/10.1002/aorn.13804
- Fayad M, Yahiaoui R, Auber F, et al. Traceability of Surgical Instruments: A Systematic Review. Appl Sci. 2025;15(3):1592. doi.org/10.3390/app15031592
- Souza RQ et al. Cost of sterilizing health products in a sterile processing department. Rev Eletr Enferm. 2015;17(2). doi.org/10.5216/ree.v17i2.27540
- Paula MAB et al. Cost of processing surgical instruments. Rev SOBECC. 2015. sobecc.emnuvens.com.br
Want to see this with your hospital’s kits?
We can talk about a pilot with indicators agreed up front, so the result is yours and not a foreign study’s.