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Intraoperative technology increases operating room times in primary total knee arthroplasty

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Optimization of patient outcomes and identification of factors to improve the surgical workflow are increasingly important. Operating room time is one modifiable factor that leads to greater hospital efficiency as well as improved outcomes such as shorter length of stay and fewer infections and readmissions. The aim of this study was to identify factors associated with operative time disparities in total knee arthroplasty (TKA).

Methods

A retrospective review of 7659 consecutive primary TKA cases was conducted. Patient demographic data, discrete operating room (OR) times, use of technology (i.e. robotic-assisted surgery, computer navigation), surgeon experience and the level of training of the first assistant were collected. Multivariate regression analysis was used to determine the effect of hospital characteristics on operative times. Operative times of five minutes or greater were considered to be clinically significant.

Results

While the use of technology (182.64 ± 39.85 vs 158.70 ± 37.45 min; B = 26.09; p < 0.0001) and greater surgeon experience (162.14 ± 39.87 vs 158.69 ± 33.18 min, B = 3.15, p = 0.002) were found to increase OR times, level of training of the first assist (161.65 vs 156.4 min; Β = − 0.264; p = 0.487) did not. Of the discrete OR times examined, incision time and total time under anesthesia were negatively impacted by the use of technology.

Conclusion

Use of technology was the only study variable found to significantly increase OR times. With increased operative times and limited evidence that technology improves long-term patient outcomes, surgeons should carefully consider the benefits and cost of technology in TKA.

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Data availability

The data used in this study are from the authors’ institution and is available from the corresponding author, RS, upon reasonable request.

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Acknowledgements

There are no acknowledgements.

Funding

This study did not receive any funding.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA

    Stephen G. Zak, David Cieremans, Alex Tang, Ran Schwarzkopf & Joshua C. Rozell

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  1. Stephen G. Zak
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  2. David Cieremans
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  3. Alex Tang
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  4. Ran Schwarzkopf
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Contributions

SZ: writing original draft, writing review and editing. DC: writing review and editing. AT: formal analysis and investigation. RS: conceptualization, writing—review and editing. JR: supervision, writing—review and editing.

Corresponding author

Correspondence to Joshua C. Rozell.

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Conflict of interest

Mr. Stephen Zak has no conflicts of interest. Mr. David Cieremans has no conflicts of interest. Mr. Alex Tang has no conflicts of interest. Dr. Ran Schwarzkopf receives royalties from Smith & Nephew; is a paid consultant for Inteljoint and Smith & Nephew; and owns stocks in Gauss surgical and Intelijoint. Ran Schwarzkopf also receives research support from Smith & Nephew. Dr. Joshua Rozell has no conflicts of interest.

Ethical approval

This study has obtained all required IRB and ethical approval at our institution.

Informed consent

This study is a retrospective review in which patients were subject to their normal standard of care. No individual data is included within this study.

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Zak, S.G., Cieremans, D., Tang, A. et al. Intraoperative technology increases operating room times in primary total knee arthroplasty. Arch Orthop Trauma Surg 143, 2113–2119 (2023). https://doi.org/10.1007/s00402-022-04468-4

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  • DOI: https://doi.org/10.1007/s00402-022-04468-4

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