Cost Effectiveness of Laminar Flow Systems for Total Shoulder Arthroplasty: Filtering Money from the OR?



Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA


Background: Laminar flow ventilation systems were developed to reduce surgical contamination in joint arthroplasty
to avoid periprosthetic joint infection (PJI). The goals of this study are to evaluate the cost-effectiveness and economic
viability of installing and maintaining a laminar flow system in an operating room.
Methods: A Monte Carlo simulation was used to evaluate the cost effectiveness of laminar flow. The variables included
were cost to treat PJI, incidence of PJI, cost of laminar flow, years of operating room use, and arthroplasty volume as
the dependent variable.
Results: Laminar flow would be financially-justified when 1,217 (SD: 319) TSA cases are performed annually with
assumed 10% reduction in PJI from laminar flow and 487 (SD: 127) with assumed 25% reduction. In a high volume OR,
laminar flow costs $25.24 per case (assuming 10% reduction) and $8.24 per case (assuming 25% reduction). Laminar
flow would need to reduce the incidence of PJI by 35.1% (SD: 9.1) to be a cost-effective strategy.
Conclusion: This analysis demonstrates the substantial arthroplasty volume and large reduction in PJI rates required to
justify the installation and maintenance costs of this technology. This high cost of implementation should be considered
prior to installing laminar flow systems.
Level of evidence: II


Main Subjects