OBJECTIVES: The reprocessing and reuse of single-use surgical instruments is a relatively common practice in hospitals in North America and Europe. Guidelines for this matter vary widely between countries, which has led to a review of the issue by the European Commission. The potential risks of this practice due to decreased functionality and safety of devices are assumed to be outweighed by economic advantages. The aim of this study was to assess the breadth and quality of evidence for the economic outcomes of multiple use of disposable surgical devices. METHODS: To build upon a previous systematic review that searched literature on this topic up to July 2007, additional literature searches were conducted across multiple electronic databases up to June 2010. RESULTS: Two published studies and one unpublished study were identified in addition to the nine studies identified by the previous systematic review by Jacobs et al. The median saving afforded by reuse compared to single use of disposable surgical devices was 40%, but outcomes ranged widely between -15% and 92%. Study quality was generally poor. One study was a randomized controlled trial, whereas the others were observational studies. Few studies included a statistical analysis and only two studies evaluated adverse event costs in addition to those of acquisition and cleaning. CONCLUSIONS: High quality studies assessing the cost-effectiveness of reusing single-use surgical devices are rare, partly due to difficulties in data collection. The economic evidence justifying this procedure is therefore inconclusive, and its value for decision making should be low. The European Commission have highlighted the lack of economic evidence as a major barrier to policy decision-making in their report from August 2010. There is a need for larger, longer-term studies adequately assessing all economic aspects of reprocessing disposable devices, including consideration of the compromised safety and functionality of devices.