The effect of an orthopedic specialty hospital on operating room efficiency in shoulder arthroplasty

UMMS Affiliation

Department of Orthopedics and Physical Rehabilitation

Publication Date


Document Type



Health Economics | Health Services Administration | Health Services Research | Orthopedics | Surgery | Surgical Procedures, Operative


BACKGROUND: Operating room (OR) time is a major cost to the health care system. Therefore, increasing OR efficiency to save time may be a cost-saving tool. This study analyzed OR efficiency in shoulder arthroplasty at an orthopedic specialty hospital (OSH) and a tertiary referral center (TRC).

METHODS: All primary shoulder arthroplasties performed at our OSH and TRC were identified (2013-2015). Manually matched cohorts from the OSH and TRC were compared for OR times. Three times (minutes) were recorded: anesthesia preparation time (APT; patient in room to skin incision), surgical time (ST; skin incision to skin closed), conclusion time (CT; skin closed to patient out of room).

RESULTS: There were 136 primary shoulder arthroplasties performed at the OSH and matched with 136 at the TRC. OSH and TRC patients were similar in age (P = .95), body mass index (P = .97), Charlson Comorbidity Index (P = 1.000), sex (P = 1.000), procedure (P = 1.000), insurance status (P = .714), discharge destination (P = .287), and diagnoses (P = .354). These matched populations had similar ST (OSH: 110.0 +/- 26.6 minutes, TRC: 113.4 +/- 28.7 minutes; P = .307). APT (39.2 +/- 8.0 minutes) and CT (7.6 +/- 3.8 minutes) were shorter in the OSH patients than APT (46.3 +/- 8.8 minutes; P < .001) and CT (11.2 +/- 4.7 minutes; P < .001) in TRC patients. Total nonoperative time (sum of APT and CT) at the OSH (46.8 +/- 8.9 minutes) was shorter than at the TRC (57.5 +/- 10.4 minutes; P < .001).

CONCLUSIONS: Despite similar patient populations and case complexity, the OR efficiency at an OSH was superior to a TRC. Further analysis is needed to determine the financial implications of this superior OR efficiency.


Primary shoulder arthroplasty, health care economics, health care policy, operating room efficiency, orthopedic specialty hospitals, practice management

DOI of Published Version



J Shoulder Elbow Surg. 2019 Jan;28(1):15-21. doi: 10.1016/j.jse.2018.06.035. Epub 2018 Sep 18. Link to article on publisher's site

Journal/Book/Conference Title

Journal of shoulder and elbow surgery

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Link to Article in PubMed

PubMed ID