Overlapping Surgery Increases Operating Room Efficiency Without Adversely Affecting Outcomes in Total Hip and Knee Arthroplasty

Abstract Background Several recent studies have demonstrated that overlapping surgeries in total hip (THA) and knee (TKA) arthroplasty does not increase the rates of complications, but whether this practice is cost-effective has yet to be addressed in the literature. The purpose of this study was to determine the effect of overlapping surgery on procedural costs and surgical productivity during THA and TKA. Methods We identified all patients undergoing primary THA or TKA from 2015-2018 by 18 surgeons at a single orthopaedic specialty hospital. Procedural and personnel costs were calculated for each case using a time-driven activity-based costing algorithm. Overlap of surgical time by at least 30 minutes was used to define an overlapping procedure. We compared costs and outcomes between overlapping and non-overlapping procedures, standardizing all costs to 8-hour time blocks. A multivariate regression analysis was performed to determine independent effect of overlapping procedures on costs and outcomes. Results Of the 4,786 consecutive procedures, 968 (20.2%) overlapped by at least 30 minutes. Although overlapping rooms increased mean operative time by 8.3 minutes (p Conclusion Overlapping non-critical portions of procedures in primary THA and TKA appears to be both a safe practice and effective strategy.