Abstract
Operative time is a potential modifiable target for reducing cost and optimizing efficiency
in total hip arthroplasty (THA). Shorter operative times are associated with decreased
costs and complications. One proposed solution for reducing operating room (OR) times
is to preferentially perform THAs at a higher volume center. The purpose of this study
is to investigate the impact of different hospital settings on mean operative time
in THA. A retrospective analysis of 7,694 consecutive primary and revision THA cases
across four different hospitals was conducted. The hospitals reviewed in this study
include a high-volume academic (HVA) orthopedic hospital, a large tertiary, low-volume
academic (LVA) center, a high-volume community (HVC) hospital, and a low-volume community
(LVC) hospital. Operative times, patient baseline demographics, and procedure classification
(inpatient vs. outpatient) were collected. For primary THA, the HVA hospital maintained
the statistically lowest total OR times followed by the HVC hospital (155.96 vs. 167.27 minutes,
p < 0.0001). The LVC and HVC centers had similar total OR times (175.48 vs. 167.27 minutes,
p = 0.578). For revision THA, the LVC center had the shortest total OR time followed
by the HVA, LVA, and HVC sites (194.85 vs. 224.69 vs. 244.07 vs. 279.54 minutes).
However, there were a larger amount of revision cases performed at our HVA sites than
our community hospitals (523 vs. 123 cases). Our HVA hospital specialized in orthopedic
care experiences shorter primary THA OR times than community hospitals. These findings
suggest that in addition to hospital volume, factors such as specialized staffing,
standardized OR protocols, and additional resources affect operative times, making
HVA centers better equipped to handle primary THA.
Keywords
operative time - total hip arthroplasty - value-based care - surgical volume - academic
hospital - community hospital
