The cost of operating room delays in an endourology center

  • Sara Maskal Case Western Reserve University School of Medicine
  • Rajat Jain
  • Donald Fedrigon III Case Western Reserve University School of Medicine
  • Emily Rose
  • Manoj Monga
  • Sri Sivalingam
Keywords: nephrolithiasis, percutaneous nephrolithotomy, ureteroscopy, healthcare costs, operating room costs, operating room delays


Introduction: This study sought to characterize delays and estimate resulting costs during nephrolithiasis surgery.

Methods: Independent observers documented delays during ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) procedures. Fifty index cases over a period of three months was considered sufficient to observe the generalizable trends. Operating room staff, excluding the surgeons, were blinded. Time-related metrics and delays preventing case progression were recorded using a smartphone-accessible data-collection instrument. Delays were categorized as: 1) missing equipment; 2) missing personnel; 3) equipment malfunction; or 4) delay due to case complexity. The first two categories were regarded as preventable and the latter two non-preventable.

Results: Forty URS and 18 PCNL cases were included. There was a total of 56 delays in 35 (65%) cases. Twelve (67%) PCNLs and 23 (58%) URSs had delays (p=0.57). The mean cumulative delay per case was 3.5±3.2 minutes. Pre-start delays (n=17) were 4.5±3.5 minutes on average while intraoperative delays (n=39) were 3.1±2.9 minutes (p=0.167). Delays were evenly spread among the four categories. Thirty-one (55%) delays were preventable (mean 3.7±3.2 minutes) while 25 (45%) were non-preventable (mean 3.2±3.2 minutes) (p=0.58). This translates to $137 per case in preventable costs.

Conclusions: Preventable operative delays are encountered frequently in nephrolithiasis surgery, translating to significant additional charges and costs. We demonstrate a rationale for the development of improved communication and workflow protocols to increase efficiency in endourological surgeries. Key limitations are the observational nature of the study and sample size.

How to Cite
Maskal, S., Jain, R., Fedrigon III, D., Rose, E., Monga, M., & Sivalingam, S. (2020). The cost of operating room delays in an endourology center. Canadian Urological Association Journal, 14(7), E304-8.
Original Research