title: An analysis of surgical and nonsurgical operating room times in high-volume shoulder arthroplasty.
abstract: BACKGROUND
  A significant portion of operating room time in shoulder arthroplasty is devoted to nonsurgical tasks. To maximize efficiency and to increase access to care, it is important to accurately quantify surgical and nonsurgical time for shoulder arthroplasty. This study aimed to evaluate surgical vs. nonsurgical time and to assess the viability of using a 1-surgeon, 2-operating room model.
  
  
  METHODS
  An institutional database was used to identify all primary and revision shoulder arthroplasty cases from February 2011 through December 2013. Time intervals were analyzed, including anesthesia and positioning time, surgical time, conclusion time, and turnover time.
  
  
  RESULTS
  We identified 1062 shoulder arthroplasties. The average anesthesia and positioning time was 48.2 ± 11.7 minutes, surgical time was 122.7 ± 36.4  minutes, and conclusion time was 10.5 ± 7.0  minutes. Average turnover time at our institution was 40 minutes. An average of 58.8 ± 13.8 minutes (33.2%) of the patient's time in the operating room was not surgical. A 1-room surgical model, with each case following the next, would allow 3 arthroplasties to be performed in a 10-hour surgical day. A 2-room model would allow 4 cases to be performed in a 9-hour surgical day or 5 in an 11-hour day. In this 2-room model, there would be no time in which the surgeon is absent for any surgical portion of the case.
  
  
  CONCLUSIONS
  For a high-volume shoulder arthroplasty practice, a 2-room model leads to greater efficiency and patient access to care without sacrificing the surgeon's presence during surgical portions of the case.
authors.affiliation: Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Padegimas
authors.affiliation: Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Hendy
authors.affiliation: Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Cassandra
authors.initials: C
authors.lastname: Lawrence
authors.affiliation: Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Devasagayaraj
authors.affiliation: Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Zmistowski
authors.affiliation: Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Abboud
authors.affiliation: Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Lazarus
authors.affiliation: Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Gerald R
authors.initials: GR
authors.lastname: Williams
authors.affiliation: Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA. Electronic address: surena.namdari@rothmaninstitute.com.
authors.forename: Surena
authors.initials: S
authors.lastname: Namdari
mesh_terms: D000368:Aged; D000072228:Arthroplasty, Replacement, Shoulder / Q000379:methods*; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms; D061646:Operative Time; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000601:surgery*; D066231:Surgeons / Q000592:standards*; D013997:Time Factors
keywords: Shoulder arthroplasty; operating room efficiency; overlapping surgery; practice management; prolonged operative time; revision shoulder arthroplasty