Travel Staff in Total Hip Arthroplasty is Associated with Increased Operating Room Costs and Decreased Efficiency.

Abstract

Introduction: Total hip arthroplasty (THA) is a cost-effective procedure that benefits from operating room (OR) efficiencies supported by consistent staff. Travel staff (TS), including travel nurses, surgical scrub technologists (ST), and registered nurse first-assists (RNFA) have been increasingly utilized, potentially introducing surgical team inconsistencies. The purpose of this study was to report on the economic impact of travel staff in THA.

Methods: A retrospective review of 947 primary THAs at a high-volume tertiary center (from April 1, 2023, to March 31, 2024) categorized procedures as manual posterior approach (PA), robotic arm-assisted (RA) PA, or direct anterior approach (DAA). Staff roles included ST, circulator (C), or RNFA, classified as TS or full-time (FT) staff. There were 13 TS-ST, 27 FT-ST, 15 TS-C, 25 FT-C, four TS-RNFA, and 20 FT-RNFA. The OR times and wasted supply costs (unused opened supplies) were tracked. The THAs with TS and FT staff were compared, adjusting for surgeon. The OR cost per minute was $46. The OR efficiency was also analyzed for cases utilizing orientee and relief staff.

Results: Travel ST impacted OR times more than travel C or RNFA (P < 0.05). The TS-ST increased OR times across all THA subgroups: RA-THA (+25 minutes, P = 0.006), PA-THA (+12 minutes, P = 0.004), and DAA-THA (+eight minutes, P = 0.009). This equates to an increased cost of $1,150, $552, and $368 for each RA-THA, PA-THA, and DAA-THA, respectively, with TS-ST. Wasted supply costs increased by an average of $58 per case (P = 0.05) with TS-ST. Orientee and relief staffing in the OR was also found to increase OR times and supply costs.

Conclusion: Travel staff in THA is associated with inefficiency and increased cost, with TS-ST having the greatest impact. This study highlights the potential economic benefit of retaining consistent, permanent surgical teams.