The Cost of an OR Minute

12.18.2020 • Industry News

By: Michelle Lemmons, RN, BSN, PHN, Clinical Educator, OR | Key Surgical

The OR is often the largest revenue and cost generating department in the hospital and has a significant impact on a hospital’s financial success. Research reveals that a single minute (60 seconds) of OR time is valued at $62.00 on average. These calculations typically include the cost of basic procedure equipment (OR table, surgical set etc), disposables, a circulating nurse, and a scrub tech or nurse, not the wages/salary of surgeons who are often paid on a “per-procedure” basis, blood products, medications, inflation, and other costly procedure-specific variables. “Most hospitals charge for a procedure in the operating room by the minute or by 15- or 60- minute segments. Many facilities round up to the next 15 minutes. A few hospitals charge a flat rate for a given number of minutes and then charge per minute if the surgeon takes longer than the average projected time. Keep in mind that when flat rates are used, they are calculated on the basis of average historical "times" so even flat rates are time dependent.”¹ Further, there are other important considerations to include that these monetary evaluations do not:

1. Increased complications
   • Increased anesthesia time for the patient.
   • A research article published in April of 2018, found that for every added minute a patient spent in the OR (up to 10 minutes) their risk of complication increased by 1%!² 
   • The average complication cost: $19,626.³
2. Surgical smoke exposure
   • Research studies confirm that surgical smoke plume contains toxic gases and vapors such as benzene, hydrogen cyanide, formaldehyde, dead and living cellular materials, and viruses.  In fact, HPV, has been found aerosolized in the surgical plume. ⁹
   • Over half of clinicians report having symptoms of surgical smoke exposure: Headache, eyes watering, sore throat dizziness etc. ⁴  
3. Opportunity Cost
   • The Surgeon and staff are tied up in surgery the whole day, even when they are not actively operating.  This has a personal and professional cost.
   • Misused OR time has also been proposed to cost the amount of time it would take to perform another full procedure,⁵  which is a financial loss for the facility and staff.

Seconds saved can add up, very quickly, to dollars saved, risks avoided, and may translate to enough time for an added procedure per day. For example, one facility found that if they made the simple change of counting 1,2 instead of 1,2,3 when transferring a patient to the OR table they were able to save 2 seconds per procedure and save their facility $12,000 per year.⁶ To the surgeon, hospital, and OR team that want to reap the benefits that time saving in the OR can produce we have the perfect solution for you. Electro Lube is an anti-stick solution for energized instruments that has been proven to reduce hand backs and save time in the OR.  Studies have shown that every time an energized instrument is removed from the field to remove eschar (a “hand-back”) research revealed that it took on average 35 seconds. In a study published in ENT magazine, Electro Lube was shown to reduce the number of hand backs per procedure from 3.4 to 0.4 and decreased OR time by 23.2%.⁷  Another study, published in the American Journal of Cosmetic Surgery, found that using Electro Lube not only decreased hand backs from 47 to 13, and decreased operating room time by 50 seconds (in a 28 minute procedure), but also found that Electro Lube assisted in ensuring adequate hemostasis, which is crucial in avoiding serious complications. ⁸ 

Let’s look at an example. The facility we just discussed, who was projected to save $12,000/ year by changing their countdown practice, has 30 operating rooms. Each operating room does 3 procedures per day.  We know that electrosurgery is used in 80% ¹⁰ of all surgical procedures, so for this facility that would be 72 of the 90 cases they do daily. If we calculate 72 procedures saving 3 hand backs per procedure which is a savings of 105 seconds per procedures at $62.00 per minute of OR time minus the cost of a bottle of Electro Lube per procedure that is a projected savings of 77,760 hand backs and $774,888 per year! The value of using Electro lube is very evident, the only question left is, are you using it yet? If not, why not?
 
References

1. Shippert, R. D. (2005). A Study of Time-Dependent Operating Room Fees and How to save $100 000 by Using Time-Saving Products. The American Journal of Cosmetic Surgery, 22(1), 25–34. doi:10.1177/074880680502200104 
2. Cheng, Hang, et al. (2018, April). Prolonged Operative Duration Is Associated with Complications: A Systematic Review and Meta-Analysis. Journal of Surgical Research, Academic Press.
3. Healy, MA., Mullard, AJ., Campbell DA Jr., Dimick, JB. (2016, September) Hospital and Payer Costs Associated with Surgical Complications. Journal of American Medical Association Surgery. (9):823-30. doi: 10.1001/jamasurg.2016.0773.
4. Llce,A., Yuzden,GE., Yavuz Van Giersbergen, M. (2017, June). The Examination of Problems Experienced by Nurses and Doctors Associated with Exposure to Surgical Smoke and Necessary Precautions. Journal of Clinical Nursing. 26(11-12):1555-1561. doi: 10.1111/jocn.13455.
5. Tsai, M. (2011). The True Cost of Operating Room Time. Archives of Surgery, 146(7), 886. doi:10.1001/archsurg.2011.163
6. Brodsky, J. B. (1998). Cost Savings in the Operating Room. Anesthesiology, 88(3), 834. doi:10.1097/00000542-199803000-00041
7. Baker, Jeffrey C., MD & Hassan H. Ramadan MD, FACS. (2012, January). The Effects of an Antistick Phospholipid Solution on Pediatric Electrocautery Adenoidectomy. ENT Journal 91(1): E20-E23.
8. Roy, S. Buckingham, H. Buckingham, E. (2017, March). The Effect of an Antistick Phospholipid Solution on Bipolar Electrocautery Efficacy in Rhytidectomy. Sage Publications. doi: 10.1177/0748806817698291.
9. https://www.cdc.gov/niosh/topics/healthcarehsps/smoke.html
10. Meeuwsen, F. C., Guédon, A. C. P., Arkenbout, E. A., van der Elst, M., Dankelman, J., & van den Dobbelsteen, J. J. (2017). The Art of Electrosurgery: Trainees and Experts. Surgical Innovation, 24(4), 373–378. doi:10.1177/1553350617705207