Brain Surgery's Supply Chain Has a Sponge Problem

Why You Can't Just Switch Brands

If your favorite cereal disappears from the grocery store, you grab a different box. Medical supply chains don't work that way.

Neurosurgical sponges and patties are regulated devices with specific FDA clearances. Hospitals can't just swap in a competitor's product overnight. They need to evaluate the alternative, ensure it meets clinical requirements, potentially retrain staff, and sometimes navigate new contracts through group purchasing organizations (GPOs), the middlemen that negotiate bulk deals for hospital networks.

And here's the kicker: Medline is one of the largest medical supply companies in the country. When a dominant supplier pulls an entire product category off the market, the remaining manufacturers often can't ramp up fast enough to fill the gap. It's the same problem that plagued semiconductor supply chains during COVID, just applied to cotton rectangles used in brain surgery.

The Ripple Effects in the OR

The FDA isn't sugarcoating the impact. Its letter states plainly that this disruption "is expected to impact patient care" and may force hospitals to adjust how they manage neurosurgery and microsurgery patients.

What does that look like in practice? The FDA is telling hospitals to reserve their remaining stock for intracranial operations (actual brain surgery) and cases where no alternative product will work. Facilities are being advised to open packages only when truly needed, since unused devices in opened packs can't be saved for later. Surgical teams should coordinate to avoid wasting product during a case.

Translation: hospitals are being asked to ration brain surgery supplies.

The downstream consequences could include delayed elective neurosurgeries, reduced operating room efficiency, and scheduling headaches across neurosurgery departments nationwide. For patients waiting on non-emergency brain or spine procedures, the timeline just got longer.

The Bigger Problem Nobody Wants to Talk About

This shortage isn't really about sponges. It's about a structural weakness in how America sources its most critical medical supplies.

The pattern is depressingly familiar. A single manufacturer dominates a product category. Hospitals and GPOs optimize their contracts for the lowest price, which often means consolidating around one or two suppliers. Everything hums along beautifully until it doesn't, and then there's no backup plan.

The FDA has been sounding alarms about this for years. The agency's Resilient Supply Chain Program is specifically trying to map out which critical devices depend on single-source suppliers, single sterilization facilities, or concentrated upstream materials. After Winter Storm Uri in 2021 knocked out resin production in Texas, the threatened device shortages prompted federal intervention—including DPA priority ratings and priority access letters—to avert widespread disruptions. Some manufacturers were still dealing with resin allocation constraints years later.

Ethylene oxide sterilization capacity (the process used to sterilize many disposable medical devices) is another chokepoint. A regulatory action or shutdown at a single contract sterilization facility can trigger shortages across dozens of unrelated product lines.

The uncomfortable truth is that many "commoditized" surgical supplies are functionally single-source at the hospital level, even when multiple manufacturers technically exist. Price optimization has quietly traded away resilience.

What Happens Next

For now, the FDA is playing defense. Its recommendations boil down to: conserve what you have, diversify your suppliers where possible, and report problems so the agency can coordinate a response. Hospitals are supposed to track daily usage, centralize their remaining inventory, and resist the urge to stockpile.

The EU, for its part, implemented a mandatory shortage-notification rule for medical devices in January 2025. The US has a mandatory shortage-notification requirement for devices only under limited conditions—during or in advance of a declared public health emergency and only for certain device categories—which means the FDA often learns about shortages reactively rather than proactively.

Medline hasn't announced when, or whether, its neurosurgical sponge line will return. Until it does, every neurosurgery department in the country is playing a careful game of inventory management with products that cost pennies per unit but are irreplaceable at the bedside.

It turns out the most fragile link in American brain surgery isn't the robot, the imaging system, or the multimillion-dollar operating suite. It's a small, absorbent rectangle that nobody thought about until it disappeared.

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