Operating room workflow across orthopaedic subspecialties: a retrospective analysis with implications for efficiency...

Non-surgical phases of operating room (OR) time represent potentially modifiable sources of inefficiency. This study analysed OR workflow patterns across orthopaedic subspecialties and identified independent risk factors for phase-specific delays.

This retrospective cohort study included 12,568 orthopaedic procedures at a tertiary academic centre (2012-2019). Procedures were classified into upper extremity (UE), lower extremity (LE), spine (Sp), and tumour (Tu). OR time was divided into preparation (Phase 1), surgical procedure (Phase 2), and exit (Phase 3). Phase durations were compared using one-way ANOVA with Bonferroni correction; effect size was assessed using eta squared (η²). Logistic regression was used to identify independent predictors of preparation delay (defined as Phase 1 duration > 55 min, the overall 75th percentile) and exit delay (Phase 3 duration > 37 min), with UE as the reference subspecialty.

Mean preparation, surgical, and exit times were 47 ± 14, 123 ± 97, and 31 ± 19 min, respectively. LE had the highest preparation phase ratio (31.5%); Sp had the longest exit time (η² = 0.055). On logistic regression, LE independently predicted preparation delay (OR 2.42, 95%CI 2.10-2.79), and Sp predicted exit delay (OR 2.83, 95%CI 2.46-3.27).

OR workflow differs significantly across orthopaedic subspecialties. Subspecialty-specific delay patterns suggest actionable targets for perioperative efficiency improvement, and systematic monitoring of non-surgical OR phases may help foster an efficiency-conscious culture in academic orthopaedic departments.