Key result
Hybrid operating rooms achieve financial sustainability at ~19 index cases per month.
Why the study?
Published economic evidence on hybrid operating rooms is sparse, focused on cost measurement, and lacks data from fee-for-service single-payer environments like Korea.
A hybrid operating room in a single-payer fee-for-service environment can achieve financial sustainability and capital recovery within its service life, though this is highly dependent on emergency surcharges and incremental revenue attribution.
Hybrid ORs may achieve sustainability under favorable single-payer reimbursement; this Level 5 analysis leaves generalizability to other systems open.
Background Hybrid operating rooms (HORs) are increasingly central to interventional and vascular practice, but the decisive barrier to adoption is the capital decision faced by administrators. Published HOR economic evidence is sparse, dominated by cost measurement rather than revenue-based recovery, and almost entirely from diagnosis-related-group settings, leaving fee-for-service single-payer environments unaddressed. Methods We performed a single-centre, room-attributed break-even and revenue-coverage analysis (hospital perspective) of a HOR at a Korean tertiary hospital over 18 months (November 2024–April 2026), testing financial sustainability with no comparator. Revenue comprised National Health Insurance (NHI) procedure fees only (excluding device, pharmaceutical, non-covered, and anaesthesia charges); a physician incentive was booked as a cost. Construction and salaries were actual; the biplane platform used the institution’s approximate outlay (KRW 3.0 billion). Sensitivity analyses (scenario, one-way, probabilistic) used staged maintenance; reporting followed CHEERS 2022. Results The 335 high-acuity index cases generated KRW 699.7 million in insured procedure-fee revenue; with other room activity (677 cases), attributed room-level revenue was KRW 51.1 million/month, rising to KRW 76.8 million with reimbursed surcharges. Throughput (18.6 index cases/month) exceeded the cash break-even (10.3–15.3). Under the most favourable revenue-attribution scenario (100% incremental), staged-maintenance capital was recovered in 5.6 years with surcharges (probabilistic median 6.3 years; 88% within 10 years) but not within the 10-year service life on base fees. Recovery was highly conditional: probabilistic median 12.1 years and 35% 10-year recovery at a 75% incremental fraction, and capital not recovered within the service life at 50%. Conclusions The rationale for a HOR is primarily clinical; this appraisal addresses the parallel financial-sustainability question. At the observed activity level the room was financially self-sustaining: attributed revenue covered its operating cost, and under the reimbursement actually received the capital outlay was projected to be recovered within the equipment service life, under the most favourable (100% incremental) revenue-attribution scenario—the shortest modelled estimate. Because that projection depends on the emergency surcharges and on how much of the attributed revenue is genuinely new to the hospital, the robust findings are the operating threshold, the required incremental fraction, and the 10-year recovery probability. The parameterised framework is transferable under single-payer fee schedules.
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Kim et al. (2026) studied Interventional and vascular procedures (n=1,012). Hybrid operating room was evaluated on Financial sustainability (break-even and revenue-coverage). A hybrid operating room was financially self-sustaining at 18.6 index cases per month, with capital outlay projected to be recovered in 5.6 years under the most favorable revenue scenario.
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