Quantifying the Opportunity Cost of Resident Involvement in Total Hip and Knee Arthroplasty
Muzamil Ahmad1, J Adam Driscoll2, Young Jee2
1Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
Background:
Resident participation in total hip arthroplasty and total knee arthroplasty (THA/TKA) is important, but the time-driven financial impact remains unclear. We quantified the "opportunity cost" of resident involvement in THA and TKA.
Methods:
Primary THA and TKA cases were identified at a single academic center (2013-2017). Cases were attending-only (AO) or resident-involved (RI). Fellows excluded. RI was stratified between juniors (postgraduate year I-III) and seniors (postgraduate year IV-V). Outcomes included operative efficiency and financial productivity. Relative value units/case were fixed at 19.6 to isolate time-driven effects.
Results:
A total of 3,217 AO and 1,148 RI THA cases, and 4,174 AO and 1,235 RI TKA cases were analyzed. RI increased operative time (THA +4.0 minutes, 95% CI [2.3, 5.7]; TKA +7.9 minutes, 95% CI [6.7, 9.1]; both p<0.001) but reduced set-up time (THA -1.7 minutes, 95% CI [-2.2, -1.2]; TKA -1.6 minutes, 95% CI [-2.0, -1.2]; both p<0.001), partially offsetting total operating room (OR) time (THA +2.3 minutes; TKA +6.3 minutes). Juniors concentrated these effects. Seniors approximated AO efficiency and had quicker THA total OR times. Per-case opportunity costs were small: operative-time (THA $36.81; TKA $76.51) and total OR time (THA $15.16; TKA $7.22). Seniors showed a $12.99 per-case savings on a THA total OR time basis.
Conclusions:
Resident participation in primary THA/TKA carries small, experience-dependent costs, partially offset with seniority and quicker set-up times. These findings may reflect anticipatory workflow gains and offer insights into schedule optimization.
