ABSTRACT Objectives Electro-medical equipment generates a high impact on the sustainability of a hospital and require high availability at a reasonable maintenance cost. The aim of this paper is to analyze the sustainability and performance of the maintenance of electro-medical equipment, through several healthcare variables (hospital admissions, surgeries, consultations, etc.), infrastructure variables (surface area, number of beds, number of operating theaters, etc.), human resources and the acquisition value of the equipment, relating them to the labor, materials and total and operative maintenance costs. Methods 4,586 electro-medical equipments were analyzed (grouped into 16 categories) installed in 12 Spanish hospitals of between 20 and 200 beds during the 2016–2018 period. Results The results show that the maintenance costs of electro-medical equipment correlate with the number of beds and operating theaters, nursing staff, equipment acquisition value, number of admissions, surgeries and the total length of hospital stay. Conclusion Different equations are proposed to estimate maintenance costs based on the variables studied. They include indicators that give an overall view of maintenance operations.