A High-Volume, Academic Orthopedic Specialty Hospital Provides the Shortest Operative Times in Total Hip Arthroplasty

Abstract

Operative time is a potential modifiable target for reducing cost and optimizing efficiency in total hip arthroplasty (THA). Shorter operative times are associated with decreased costs and complications. One proposed solution for reducing operating room (OR) times is to preferentially perform THAs at a higher volume center. The purpose of this study is to investigate the impact of different hospital settings on mean operative time in THA. A retrospective analysis of 7,694 consecutive primary and revision THA cases across four different hospitals was conducted. The hospitals reviewed in this study include a high-volume academic (HVA) orthopedic hospital, a large tertiary, low-volume academic (LVA) center, a high-volume community (HVC) hospital, and a low-volume community (LVC) hospital. Operative times, patient baseline demographics, and procedure classification (inpatient vs. outpatient) were collected. For primary THA, the HVA hospital maintained the statistically lowest total OR times followed by the HVC hospital (155.96 vs. 167.27 minutes, p < 0.0001). The LVC and HVC centers had similar total OR times (175.48 vs. 167.27 minutes, p = 0.578). For revision THA, the LVC center had the shortest total OR time followed by the HVA, LVA, and HVC sites (194.85 vs. 224.69 vs. 244.07 vs. 279.54 minutes). However, there were a larger amount of revision cases performed at our HVA sites than our community hospitals (523 vs. 123 cases). Our HVA hospital specialized in orthopedic care experiences shorter primary THA OR times than community hospitals. These findings suggest that in addition to hospital volume, factors such as specialized staffing, standardized OR protocols, and additional resources affect operative times, making HVA centers better equipped to handle primary THA.