OPTIMIZING EFFICIENCY AND REDEFINING BENCHMARKS IN A HIGH-VOLUME PRIMARY ARTHROPLASTY PROGRAMME

With rising overhead costs and an increase in demand for total hip arthroplasty (THA) and total knee arthroplasty (TKA), it vital that arthroplasty programs maximize operating room (OR) efficiency. Most surgical centers use a target of four joints operated within an eight-hour shift in one OR, with the benchmarks to meet this quota being well-defined. Using a slim approach, we set out to redefine benchmarks to support the successful operation of five joints within the same setting. Fitting in an extra joint per operative day would have benefits for all shareholders including significantly decreased wait times and cost-per-case. After institutional review board approval, from February 25th to October 25th, 2023, six fellowship-trained surgeons, and thirteen anesthesiologists participated in 59 five joint days (295 cases): 134 THA and 161 TKA. Patients included 160 females and 135 males; mean age, 67; mean body mass index (BMI), 29 kg/m2; American Society of Anesthesiologist score (ASA), 2. Hospital records demonstrated time data, demographics, adverse events, and anesthetic details. Key time points were defined, including the anesthesia preparation time (APT), time from the patient entering the room to anesthesia being ready; surgical preparation time (SPT), time from anesthesia ready to case start; time of the procedure, case start to case finish; anesthesia finish time (AFT), case finish to patient exiting the OR; and turnover, patient exit to next patient in OR (Figure 1). Data was analyzed using SPSS. The median and min/max for each time point were as follows: APT median of 11 minutes (Min 1, Max 41), SPT 9 minutes (Min 1, Max 33), procedure 55 minutes (Min 37, Max 153), AFT 3 minutes (Min 0, Max 28), turnover 17 minutes (Min 0, Max 42). The median total time for a five-joint day was 472 minutes, which falls under the 480 minutes of a standard OR. The reported medians should be defined as benchmarks to ensure the successful completion of five joint OR days, even finishing with time to spare. Without any intervention, out of 59 five joint days, there was a 52.5% (31/59) success rate in finishing by 3:30 PM. These results demonstrate the feasibility of incorporating five joint days as the new standard, even before utilizing the newly defined benchmarks to mark progression through an OR day. With the new benchmarks, standardized five joint days would decrease the load on our strained healthcare system, as well as provide a welcome reduction in costs per patient. Redefining operative benchmarks to allow for the successful completion of five joints per standard OR day is a critical step in moving from the traditional four joint OR day to five joints. By making this transition to five joints, shareholders including the patient, surgeons, and healthcare administrators all experience benefits with lower overhead costs per case, increased patient throughput and greater team coherency and opportunities for improvement. For any figures or tables, please contact the authors directly.

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