INTRODUCTION: The National Health Service (NHS) is struggling to meet elective surgery recovery targets set by the UK government. Increasing productivity by maximising the number of cases performed through current operating list capacity will be crucial to reduce waiting times. METHODS: This is a retrospective analysis of total hip replacement (THR) procedures performed in a single NHS general hospital using cemented or uncemented prostheses. Data were collected routinely between August 2007 and May 2009. A probabilistic analysis using the Monte Carlo simulation approach was conducted to estimate the probability of completing four cemented or four uncemented THR surgeries within a standard 8-h operating list, and if there was a 15- or a 30-min start delay. RESULTS: There were 236 surgeries with a cemented prosthesis (mean surgical case time 117.96min) and 333 using an uncemented prosthesis (mean surgical case time 101.54min). For the standard operating list duration of 8h, the probability of completing four cemented hip replacements was approximately 63%, compared with 96% for uncemented procedures. Delayed starts of 15 and 30min resulted in significant reductions in the probability of completing four cemented procedures, decreasing to 44% and 26%, respectively. Uncemented procedures were less affected by these delays, with probabilities of 93% and 87%, respectively. CONCLUSIONS: The use of uncemented prostheses, where clinically suitable, may contribute to increased theatre throughput within current NHS operating list capacity.
Wainwright et al. (Tue,) studied this question.