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

Document Type : RESEARCH PAPER

Authors

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

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

Main Subjects

References

1. Sloan M, Premkumar A, Sheth NP. Projected Volume of 
Primary Total Joint Arthroplasty in the U.S., 2014 to 2030. J 
Bone Joint Surg Am. 2018; 100(17):1455-1460. 
doi:10.2106/JBJS.17.01617.
2. Fang CJ, Shaker JM, Hart PA, et al. Variation in the Profit 
Margin for Different Types of Total Joint Arthroplasty. J Bone 
Joint Surg Am. 2022; 104(5):459-464. 
doi:10.2106/JBJS.21.00223.
3. Healey T, El-Othmani MM, Healey J, Peterson TC, Saleh KJ. 
Improving Operating Room Efficiency, Part 1: General 
Managerial and Preoperative Strategies. JBJS Rev. 2015; 3(10) 
doi:10.2106/JBJS.RVW.N.00109.
4. Bieganowski T, Christensen TH, Bosco JA, Lajam CM, 
Schwarzkopf R, Slover JD. Trends in Revenue, Cost, and 
Contribution Margin for Total Joint Arthroplasty 2011-2021. J 
Arthroplasty. 2022; 37(11):2122-2127.e1. 
doi:10.1016/j.arth.2022.05.005.
5. Gonzalez TA, Bluman EM, Palms D, Smith JT, Chiodo CP. 
Operating Room Time Savings with the Use of Splint Packs: A 
Randomized Controlled Trial. Arch Bone Jt Surg. 2016; 
4(1):10-15.
6. Overdyk FJ, Harvey SC, Fishman RL, Shippey F. Successful 
strategies for improving operating room efficiency at 
academic institutions. Anesth Analg. 1998; 86(4):896-906. 
doi:10.1097/00000539-199804000-00039.
7. Rothstein DH, Raval MV. Operating room efficiency. Semin 
Pediatr Surg. 2018; 27(2):79-85. 
doi:10.1053/j.sempedsurg.2018.02.004.
8. Attarian DE, Wahl JE, Wellman SS, Bolognesi MP. Developing 
a high-efficiency operating room for total joint arthroplasty in 
an academic setting. Clin Orthop Relat Res. 2013; 
471(6):1832-6. doi:10.1007/s11999-012-2718-4.
9. Bhatt AS, Carlson GW, Deckers PJ. Improving operating room 
turnover time: a systems based approach. J Med Syst. 2014; 38(12):148. doi:10.1007/s10916-014-0148-4.
10. Cerfolio RJ, Ferrari-Light D, Ren-Fielding C, et al. Improving 
Operating Room Turnover Time in a New York City Academic 
Hospital via Lean. Ann Thorac Surg. 2019; 107(4):1011-1016. 
doi:10.1016/j.athoracsur.2018.11.071.
11. Friedman DM, Sokal SM, Chang Y, Berger DL. Increasing 
operating room efficiency through parallel processing. Ann 
Surg. 2006; 243(1):10-4. 
doi:10.1097/01.sla.0000193600.97748.b1.
12. Smith MP, Sandberg WS, Foss J, et al. High-throughput 
operating room system for joint arthroplasties durably 
outperforms routine processes. Anesthesiology. 2008; 
109(1):25-35. doi:10.1097/ALN.0b013e31817881c7.
13. Cichos KH, Hyde ZB, Mabry SE, et al. Optimization of 
Orthopedic Surgical Instrument Trays: Lean Principles to 
Reduce Fixed Operating Room Expenses. J Arthroplasty. 
2019; 34(12):2834-2840. doi:10.1016/j.arth.2019.07.040.
14. Boggs SD, Tsai MH, Urman RD, Directors AoAC. The 
Association of Anesthesia Clinical Directors (AACD) Glossary 
of Times Used for Scheduling and Monitoring of Diagnostic 
and Therapeutic Procedures. J Med Syst. 2018; 42(9):171. 
doi:10.1007/s10916-018-1022-6.
15. Childers CP, Maggard-Gibbons M. Understanding Costs of 
Care in the Operating Room. JAMA Surg. 2018; 
153(4):e176233. doi:10.1001/jamasurg.2017.6233.
16. Watters TS, Mather RC, Browne JA, Berend KR, Lombardi AV, 
Bolognesi MP. Analysis of procedure-related costs and 
proposed benefits of using patient-specific approach in total 
knee arthroplasty. J Surg Orthop Adv. 2011; 20(2):112-6.
17. Webster I. Alioth Finance. Inflation Calculator, U.S. Official 
Inflation Data. Available at: https://www.officialdata.org/. 
Accessed October 4, 2023. 
18. Healy WL, Iorio R. Implant selection and cost for total joint 
arthroplasty: conflict between surgeons and hospitals. Clin 
Orthop Relat Res. 2007; 457:57-63. 
doi:10.1097/BLO.0b013e31803372e0.
19. Ly JA, Wang WL, Liss FE, Ilyas AM, Jones CM. Comparative 
Cost Analysis of Single-use Sterile versus Reprocessed Distal 
Radius Volar Plate Sets. Arch Bone Jt Surg. 2022; 10(5):420-
425. doi:10.22038/ABJS.2021.57852.2872
20. Small TJ, Gad BV, Klika AK, Mounir-Soliman LS, Gerritsen RL, 
Barsoum WK. Dedicated orthopedic operating room unit 
improves operating room efficiency. J Arthroplasty. 2013; 
28(7):1066-1071.e2. doi:10.1016/j.arth.2013.01.033.
21. Zimmer Biomet. “Zimmer Biomet ASC Solutions: 3. Care 
Optimization.” Available at: 
https://www.zimmerbiomet.com/en/products-andsolutions/asc-solutions.html#03-care-optimization. 
Accessed October 4, 2023.
The Archives of Bone and Joint Surgery
Volume 12, Issue 9
September 2024
Pages 660-664

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History

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

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