A Simple Subjective Surgical Complexity Score for Surgical Planning in Total Knee Arthroplasty Helps to Improve Surgical Efficiency and Reduce Costs

Background: Efficient operating room (OR) management reduces the potential for extended OR days.Surgical schedulers play a key role in generating OR schedules, despite unfamiliarity with specific case considerations that may affect case length.We evaluated the correlation between a single surgeon's subjective preoperative complexity scoring system and the resulting total knee arthroplasty (TKA) procedure time, and secondarily to assess the financial losses generated from unaccounted OR time.Methods: All patients at the index institution who received a primary, unilateral TKA from February 2014 to November 2019 with a documented tourniquet time and assigned complexity score were included (n = 551).Patient and surgery-specific characteristics were recorded, including the score that was assigned at the preoperative visit.Case length was determined by tourniquet time.The rate of underestimating room duration was estimated from the booking time.Average supply and labor costs as well as surgical and anesthesia charges were tabulated across four providers (one utilizing the score and three not utilizing the score).Results: Preoperative complexity score was positively correlated with tourniquet time (p < 0.001, = 0.196).Operations with complexity scores of 1, 2, and 3 had a mean tourniquet time of 59 minutes, 64.2 minutes, and 76 minutes, respectively (p < 0.001).The surgical assistant training level did not correlate with a longer tourniquet time (p = 0.492).The attending utilizing the score only underestimated the booking time at a rate of 4% with a significantly shorter room duration (131 minutes) while the remaining attendings underestimated the required booking time at a rate of 72% with a longer room duration (151 minutes; p < 0.05).The average cost savings per case between attendings that did not use the complexity score and the attending that did was $4,462.17($223.11per minute).Conclusion: Our complexity score correlated with OR time and may aid in enhancing OR efficiency by incorporating it into scheduling algorithms, and reducing the direct variable operating cost burden of primary TKAs.