Key result
High-efficiency tiered operating rooms cut costs ~60% vs conventional rooms with equivalent health outcomes.
Why the study?
Wait times for elective orthopedic procedures in Ontario have become unacceptably long, prompting testing of a novel resource-saving tiered operating room redesign to improve efficiency and reduce wait times.
Does a high-efficiency tiered operating room strategy reduce costs and maintain patient health outcomes compared to a conventional operating room in adult patients undergoing elective ambulatory lower limb orthopedic surgery?
RCT (n=199)
Open-label
Randomly assigned
No
Does a high-efficiency tiered operating room strategy reduce costs and maintain patient health outcomes compared to a conventional operating room in adult patients undergoing elective ambulatory lower limb orthopedic surgery?
A tiered, high-efficiency operating room strategy for ambulatory orthopedic surgery substantially reduces costs without compromising patient health outcomes or satisfaction.
Supports tiered high-efficiency OR adoption in ambulatory orthopedics to reduce costs; extends RCT evidence for efficiency without outcome trade-offs.
BACKGROUND: Wait times for many elective orthopedic surgical procedures in Ontario have become unacceptably long and substantially exceed the recommended guidelines. As a consequence, many patients experience chronic pain, disability and other poor health outcomes. The purpose of this study was to test a novel, resource-saving redesign of outpatient operating room (OR) services, based on tiered grouping of surgical cases, to maximize health benefits for patients while improving efficiency and decreasing wait times. METHODS: This prospective cohort study enrolled adult patients scheduled to undergo unilateral lower limb procedures that had a low requirement for surgical resources and did not require admission to the hospital (ambulatory surgical services) at an academic hospital. Patients were randomly assigned to a conventional OR group or a high-efficiency (tiered) OR group, in which the intensity of surgical, anesthesia and nursing resources was matched to the procedure and the patient's health status. The tiered OR made use of local anesthesia and a block room rather than general anesthesia. Primary outcomes were costs of surgical services provided and patient health outcomes; secondary outcomes were patient and staff satisfaction with each OR setup. RESULTS: The costs associated with the high-efficiency OR were 60% lower than those associated with the conventional OR (this was primarily due to the streamlining of OR care and elimination of the need to use a postanesthetic care unit), with the same or equivalent patient health outcomes. No differences in patient and staff satisfaction were found between the 2 setups. CONCLUSION: The use of tiered, ambulatory services for elective orthopedic surgery does not compromise health outcomes and patient satisfaction, and it is associated with substantial cost savings.
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Chohan et al. (2022) conducted an RCT in Elective unilateral lower limb orthopedic procedures (n=199). High-efficiency (tiered) operating room vs. Conventional operating room was evaluated on Costs associated with surgical and patient care per patient (in Canadian dollars). The high-efficiency tiered operating room strategy reduced surgical and patient care costs by 60% ($319 vs $789) compared to the conventional operating room, with equivalent patient health outcomes.
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