Do perioperative efficiency changes compromise patient outcomes in primary hip and knee arthroplasty?

Maximizing operating room (OR) efficiency has gained traction amongst surgeons with the growing demand for total joint arthroplasties (TJA). The shift towards orthopaedic-focused ambulatory surgical centers (ASCs) has made optimizing OR time more feasible. Overlapping surgeries and reducing redundant instrumentation have been shown to enhance efficiency without compromising patient outcomes. This study evaluates an OR efficiency optimization program's impact on 90-day patient outcomes in a high-volume ASC setting.

Prospectively collected data were queried for all primary TJA performed by a single surgeon at two stand-alone ASCs between July 2023 and December 2024. Those cases prior to OR efficiency optimization (traditional) were compared to those after changes were implemented (optimization). Efforts included increasing perioperative process efficiency, avoiding room delays, and improving team communication. Outcomes measured included the mean number of cases per OR day, complication and revision rates, and patient-reported outcome measures (PROMs).

In the traditional cohort, 8.7 cases were performed per day compared to 9.9 cases in the optimization cohort. Total OR time decreased by 11 min per case. All-cause revision rates (0.4% in both cohorts) and complication rates (3.67% vs 3.08%) showed no statistically significant difference (P > 0.05). No clinically important changes in PROMs were observed between the two cohorts.

ASC process efficiency can increase surgical throughput while maintaining similar patient outcomes. Optimized OR flow and improved team dynamics can help meet the growing demand for TJA, ensuring a sustainable and efficient surgical environment. Future studies may evaluate large cohorts with longer follow-up.