Operating room efficiency of orthopedic surgery during the COVID-19 era.

OBJECTIVE: The COVID-19 pandemic forced operating rooms (ORs) to adopt new safety protocols. Although these measures protected the health of patients and providers, their impact on OR efficiency remains unclear. Our objective was to further elucidate the effects of COVID-19 on orthopedic surgery OR efficiency. STUDY DESIGN: This was a retrospective study of 14,856 orthopedic surgeries performed between December 1, 2019, and October 31, 2021. METHODS: Institutional perioperative databases were used to identify relevant orthopedic surgeries. The onset of the COVID-19 period was set as March 12, 2020, when a state of emergency was declared in Tennessee. Both 90-day periods before and after this date were used for comparative analysis of the pre-COVID-19, peak-restrictions, and post-peak-restrictions time periods. Delay of first case start time and turnover time between cases were used as primary measures of efficiency. RESULTS: There were 1853 pre-COVID-19 cases, 1299 peak-restrictions cases, and 11,704 post-peak-restrictions cases analyzed. Delay of first case start time was found to be significantly different among the time periods (mean [SD] minutes, 7 [14] vs 8 [18] vs 7 [17], respectively; P < .001). Turnover time between cases was also significantly different among the time periods (62 [49] vs 66 [51] vs 64 [51]; P = .002). CONCLUSIONS: Although significant, there was minimal absolute change in orthopedic OR efficiency during the onset of the pandemic. These results suggest that the protocols enacted at our institution appropriately maintained orthopedic OR efficiency, even in the context of the rapidly increasing COVID-19 burden.

The cost of a plastic surgery team assisting with cranioplasty.

OBJECTIVES: Cranioplasty is a commonly performed neurosurgical procedure that restores cranial anatomy. While plastic surgeons are commonly involved with cranioplasties, the cost of performing a cranioplasty with neurosurgery alone (N) vs. neurosurgery and plastic surgery (N + P) is unknown. METHODS: A single-center, multi-surgeon, retrospective cohort study was undertaken on all cranioplasties performed from 2012 to 22. The primary exposure variable of interest was operating team, comparing N vs. N + P. Cost data was inflation-adjusted to January 2022 using Healthcare Producer Price Index as calculated by the US Bureau of Labor Statistics. RESULTS: 186 patients (105 N vs. 81 N + P) underwent cranioplasties. The N + P group has a significantly longer length-of-stay (LOS) 4.5 ± 1.6days, vs. 6.0 ± 1.3days (p < 0.001), but no significant difference in reoperation, readmission, sepsis, or wound breakdown. N was significantly less expensive than N + P during both the initial cranioplasty cost ($36,739 ± $4592 vs. $41,129 ± $4374, p 0.014) and total cranioplasty costs including reoperations ($38,849 ± $5017 vs. $53,134 ± $6912, p < 0.001). Univariable analysis (threshold p = 0.20) was performed to justify inclusion into a multivariable regression model. Multivariable analysis for initial cranioplasty cost showed that sepsis (p = 0.024) and LOS (p = 0.003) were the dominant cost contributors compared to surgeon type (p = 0.200). However, surgeon type (N vs. N + P) was the only significant factor (p = 0.011) for total cost including revisions. CONCLUSIONS: Higher costs to N + P involvement without obvious change in outcomes were found in patients undergoing cranioplasty. Although other factors are more significant for the initial cranioplasty cost (sepsis, LOS), surgeon type proved the independent dominant factor for total cranioplasty costs, including revisions.