The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

An Efficiency Model for Decreasing Operative Room Turnover Time for Total Joint Arthroplasties

Document Type : RESEARCH PAPER

Authors
Kathryn Hedden 1
Samantha Harrer 1
Jong Hyun Choi 1
Pietro M. Gentile 1
Alisina Shahi 2
Matthew L. Brown 3
1 Department of Orthopaedic Surgery, Cooper University Health Care, Camden, NJ, USA
2 Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
3 Department of Orthopaedic Surgery, Cooper University Health Care, Camden, NJ, USA- Department of Orthopaedic Surgery, Cooper Medical School of Rowan University, Camden, NJ, USA
10.22038/abjs.2024.77381.3575
Abstract
Objectives: Despite an increased demand for total joint arthroplasty (TJA), rising health-care costs and 
bundling of payments by payers have shifted the focus to improving operating room (OR) efficiency. 
This study aimed to assess the efficacy of an efficiency model that optimized instrument trays o n 
decreasing OR turnover time (TOT) and the benefits made possible by this improved efficiency.
Methods: All primary TJA procedures performed by a single fellowship-trained surgeon from January 2022 to 
August 2023 were reviewed. The surgeon partnered with Zimmer Biomet to condense the total knee and total hip 
arthroplasty instrument trays from seven to three trays each. Patient in OR time and patient out of OR times were 
collected and used to calculate TOT. Mean TOTs pre-efficiency model implementation (January – October 2022) 
and post-efficiency model implementation (March – August 2023) were compared. Annual cost savings were 
calculated based on an average cost per one minute of OR time of $47.99 and an average cost for the Sterile 
Processing Department (SPD) to process a single TJA tray of $79.41.
Results: Following implementation of the efficiency model, the average OR TOT significantly decreased by 19 
minutes (P < 0.0001), a greater than 44% reduction in TOT. At this surgeon’s current case volume, conservatively 
estimated at 280 primary TJA cases per year, annual savings in OR and SPD processing costs were $169,597 and 
$88,939, respectively. Moreover, this led to increased case volume per operative day.
Conclusion: A small-scale intervention such as optimizing instrument trays for TJA is a valuable and sustainable 
solution to improve efficiency in the OR by decreasing OR TOT, thereby generating considerable cost-savings and 
opportunity to increase surgical volume.
 Level of evidence: III
Keywords
Efficiency
Instrument tray
Total hip arthroplasty
Total knee arthroplasty
Turnover time
Subjects
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The Archives of Bone and Joint Surgery
Volume 12, Issue 9
September 2024
Pages 660-664

  • Receive Date 10 January 2024
  • Revise Date 09 July 2024
  • Accept Date 12 June 2024