Flip Lists in Elective Hip and Knee Arthroplasty: A Retrospective Cohort Study on Efficiency and Patient Outcomes

Aims This study evaluates the impact of implementing a 'flip list' approach in elective orthopaedic surgery on surgical efficiency, patient satisfaction, and resource utilisation. Methods A retrospective cohort study was conducted at South West London Elective Orthopaedic Centre, Epsom General Hospital, London, using prospectively collected data from a high-volume elective orthopaedic centre between August 2019 and April 2024. A total of 373 surgical lists (116 flip, 257 non-flip) involving 1,079 procedures were analysed. A total of 859 arthroplasties were analysed (523 total hip arthroplasty (THA), 326 total knee arthroplasty (TKA), and 10 unicompartmental knee arthroplasty (UKA) cases). Data included patient demographics, intraoperative variables, and post-operative outcomes. Key outcomes included theatre efficiency (procedure count, duration, touch time), postoperative outcomes (length of stay, complication/readmission rates), patient-reported outcome measures (PROMs)/patient-reported experience measures (PREMs), and income generated. Statistical analysis was performed using t-tests, Chi-square, and Fisher's exact tests (p < 0.05 considered significant). Results Flip lists facilitated significantly more procedures per list (3.17 vs. 2.77; p < 0.001) with reduced operative duration (68 vs. 91 minutes) and shorter hospital stays (1.83 vs. 2.24 days; p < 0.001). No significant differences were observed in complication rates, readmissions, mortality, or patient-reported outcomes over a two-year follow-up. Economic analysis showed comparable income per case, but greater total revenue per list due to increased volume. Conclusion Flip lists enhance theatre efficiency and throughput in elective arthroplasty without compromising safety or patient satisfaction. The model aligns with Getting It Right First Time (GIRFT) principles and offers a scalable, high-impact solution for emerging high-volume elective orthopaedic centres aiming to meet rising demands whilst maintaining quality of care.