Evaluating Productivity and Costs Associated with Overlapping Surgeries

    Editor’s Note: Research papers intended for presentation at the canceled annual meeting of the American Academy of Orthopaedic Surgeons are now available online at the AAOS Virtual Education Experience. We’ll be highlighting a few of the more interesting papers throughout the summer.

    The rationale for overlapping surgeries is that it allows orthopaedic surgeons to perform more procedures in a day, making efficient use of their OR time and, thus, improving access to care for patients.

    Is that the reality? Does the practice of overlapping surgeries really translate to more procedures?

    Yes, it does, according to a study from The Rothman Institute that examined productivity and cost-effectiveness of overlapping total joint arthroplasty procedures among 18 Rothman surgeons.

    Between 2015 and 2018, these surgeons performed 968 primary total hip and total knee arthroplasty procedures – about 20% of the primary total joint procedures for the study period – that overlapped by at least 30 minutes with another case. The researchers used a time-driven, activity-based costing algorithm to calculate personnel and procedural costs for these cases, and then standardized all costs to 8-hour time blocks.

    When comparing costs and outcomes of overlapping versus non-overlapping cases, the researchers found that mean operative time and OR personnel costs were higher for the overlapping surgeries. However, surgeons with overlapping cases could perform more procedures in an 8-hour time block than surgeons whose cases did not overlap (7.6 vs 6.4; P<0.0001). The profit margin per 8-hour time block increased by $1215 for each overlapped procedure.

    Significantly, the researchers found no differences between groups in:

    • 90-day readmission rate (2% vs 2%; P=0.4653)
    • Length of stay (1.14 vs 1.15 days; P=0.8253)
    • Discharge to home (98% vs 98%; P=0.4389)

    “Overlapping non-critical portions of procedures in primary THA and TKA appears to be both a safe practice and effective strategy to significantly increase surgical productivity,” the researchers concluded.


    Yayac M, Wills B, Wilt Z, Austin M, Courtney PM. Overlapping Surgery Increases Operating Room Efficiency without Adversely Affecting Outcomes in Total Hip and Knee Arthroplasty. Paper 727. AAOS Virtual Education Experience.