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Operating room workflow across orthopaedic subspecialties: a retrospective analysis with implications for efficiency
Kengo Harato1,2,3, Shu Kobayashi4,5, Akihito Oya4,5
1Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan. harato@keio.jp.
International Orthopaedics
|May 10, 2026
Summary
Orthopaedic operating room (OR) workflow varies by subspecialty, with lower extremity procedures causing preparation delays and spine surgeries leading to longer exit times. Optimizing these non-surgical phases can improve OR efficiency.
Area of Science:
- Orthopaedic Surgery
- Healthcare Operations Management
- Perioperative Efficiency
Background:
- Non-surgical phases of operating room (OR) time are significant sources of inefficiency.
- Identifying and addressing delays in these phases is crucial for improving patient flow and resource utilization.
Purpose of the Study:
- To analyze operating room (OR) workflow patterns across different orthopaedic subspecialties.
- To identify independent risk factors contributing to phase-specific delays within the OR.
Main Methods:
- Retrospective cohort study of 12,568 orthopaedic procedures (2012-2019).
- Classification into upper extremity (UE), lower extremity (LE), spine (Sp), and tumour (Tu) subspecialties.
- Analysis of preparation (Phase 1) and exit (Phase 3) delays using logistic regression, with UE as the reference.
Main Results:
- Lower extremity (LE) procedures were independently associated with preparation delays (OR 2.42).
- Spine (Sp) procedures were independently associated with longer exit times (OR 2.83).
- Significant workflow differences were observed across orthopaedic subspecialties.
Conclusions:
- Orthopaedic subspecialty dictates distinct OR workflow patterns and delay risks.
- Targeted interventions for specific subspecialties can enhance perioperative efficiency.
- Systematic monitoring of non-surgical OR phases promotes an efficiency-focused culture in academic departments.