Operating room efficiency and cost reduction in shoulder arthroplasty: is there an advantage of a dedicated operating room team?

Abstract

Operating room (OR) efficiency is a crucial component in the delivery of high quality, cost-efficient healthcare in orthopedic shoulder arthroplasty, and generally in surgery. Utilizing a dedicated OR team may lead to higher clinical efficiency by potentially reducing total OR time and cost while avoiding operational redundancies or errors. The purpose of this study is to identify specific parameters influencing OR efficiency with a 2-roomed system with dedicated OR staff and evaluate its influence on operational cost of the OR per min. From 2017 to 2018, 348 patients underwent primary shoulder arthroplasty at one institution, that had 2 established OR systems: A traditional “1-room” system (TS) with general OR staff, and a “2-room” shoulder service (SS) with a dedicated OR team. Medical health records were accessed to obtain pertinent study data, which included demographics, surgical indication, and time-points per surgical case. Anesthesia preparatory time (APT) was time from patient OR entry to skin incision; surgery time (ST) – from skin incision to skin closure; conclusion time (CT) – from skin closure to patient exiting OR; and turnover time (TT) – time from 1 patient's exiting to the next patient's admittance into the OR. Nonoperative time was a summation of APT, CT, and TT, while Total OR time comprised of nonoperative time and ST. Cost equivalent per minute OR operation was then used to calculate differences between the 2 interest groups. The SS treated 270 patients (77.6%) and TS treated 78 patients (22.4%). The SS demonstrated a 74 minutes decrease in total OR time (116 vs. 190 minutes) when compared to the TS ( P < .0001). When surgeon factor (“surgery time”) was removed, the SS consistently demonstrated a 23-minute decrease in nonoperative time (76 vs. 99 minutes, P < .0001) and a 26-minute decrease in turnover time (14 vs. 40 minutes, P < .0001) – about a 3-fold reduction. When analyzing cost, the SS demonstrated a $291 decrease in nonoperative cost per case ($1090 vs. $1381, P < .0001) despite the staffing cost of 3 floating staff members. The TT reduction translated to $360 savings in OR cost per case ($198 vs. $558, P < .0001). A dedicated OR team using 2 ORs improves both clinical efficiency (decreases total OR time) and reduces cost (decreases total OR cost) - despite having more staff members and associated staffing costs - compared to a traditional 1-room system. When surgeon-specific factors were removed, the largest reduction in OR cost was associated with decrease in turnover time. Level III.