How Long is Orthopaedic Team Work Time During the Surgical Encounter for Outpatient Total Joint Arthroplasty?

Outpatient total joint arthroplasty (TJA) volume has increased substantially, while cuts to reimbursement for primary TJA have been continually reduced by the Centers for Medicare and Medicaid Services (CMS). This study quantified the total time an orthopaedic team dedicated to patient care on the day of surgery for outpatient primary TJA.

A total of 14,564 primary total hip (41.6%) and knee (58.4%) arthroplasties (THAs and TKAs) performed at 15 statewide facilities were retrospectively reviewed. A total of 45.6% of patients were discharged on the same day of surgery. The total work time was operationally defined as the time in minutes the orthopaedic team spent providing care from patient arrival to discharge, including preoperative tasks, intraoperative services, and discharge preparation.

The mean total work time spent per arthroplasty was 226.5 minutes (THA 232.2, TKA 222.4), with a mean operating room time of 128.5 minutes (THA 134.3, TKA 124.3), a mean setup time of 34.7 minutes (THA 36.9, TKA 33.0), and a procedure time 86.4 minutes (THA 89.8, TKA 83.9). The mean total work time for THAs was significantly longer compared to TKAs (P < 0.001). The mean total work time was 211.4 minutes for patients discharged the same day and 239.0 minutes for those discharged after an overnight stay (P < 0.001).

The average total work time for the orthopedic team per primary outpatient TJA was 227 minutes (approximately 3.8 hours), with a mean procedure time comparable to similar studies. Arthroplasty surgeons have improved efficiency while maintaining excellent outcomes. These findings support maintaining work relative value units for primary TJA rather than implementing further reductions.