Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Original Investigation

Contribution margin per hour of operating room to reallocate unutilized operating room time: a cost-effectiveness analysis

Margem de contribuição por hora de sala cirúrgica para realocar o tempo não utilizado da sala cirúrgica: uma análise de custo-efetividade

Andrea Saporito, Davide La Regina, Andreas Perren, Luca Gabutti, Luciano Anselmi, Stefano Cafarotti, Francesco Mongelli

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Background and objectives
Contribution margin per hour (CMH) has been proposed in healthcare systems to increase the profitability of operating suites. The aim of our study is to propose a simple and reproducible model to calculate CMH and to increase cost-effectiveness.

For the ten most commonly performed surgical procedures at our Institution, we prospectively collected their diagnosis-related group (DRG) reimbursement, variable costs and mean procedural time. We quantified the portion of total staffed operating room time to be reallocated with a minimal risk of overrun. Moreover, we calculated the total CMH with a random reallocation on a first come-first served basis. Finally, prioritizing procedures with higher CMH, we ran a simulation by calculating the total CMH.

Over a two-months period, we identified 14.5 hours of unutilized operating room to reallocate. In the case of a random “first come–first serve” basis, the total earnings were 87,117 United States dollars (USD). Conversely, with a reallocation which prioritized procedures with a high CMH, it was possible to earn 140,444 USD (p < 0.001).

Surgical activity may be one of the most profitable activities for hospitals, but a cost-effective management requires a comprehension of its cost profile. Reallocation of unused operating room time according to CMH may represent a simple, reproducible and reliable tool for elective cases on a waiting list. In our experience, it helped improving the operating suite cost-effectiveness.


Operating Rooms,  Cost-Benefit Analysis,  Health Facilities,  Health Care Costs,  Elective Surgical Procedures



A margem de contribuição por hora (MCH) foi proposta nos sistemas de saúde para aumentar a lucratividade das salas cirúrgicas. O objetivo do nosso estudo é propor um modelo simples e reprodutível para calcular o MCH e aumentar o custo-efetividade.


Para os dez procedimentos cirúrgicos mais comumente realizados em nossa instituição, coletamos prospectivamente o reembolso do grupo relacionado ao diagnóstico (GRD), custos variáveis e tempo médio de procedimento. Quantificamos a parcela do tempo total da sala de cirurgia a ser realocada com um risco mínimo de superação. Além disso, calculamos o MCH total com uma realocação aleatória por ordem de chegada. Por fim, priorizando procedimentos com maior MCH, fizemos uma simulação calculando o MCH total.


Durante um período de dois meses, identificamos 14,5 horas de sala cirúrgica não utilizada para realocar. No caso de uma base aleatória de “primeiro a chegar, primeiro a servir”, os ganhos totais foram de 87.117 dólares americanos (USD). Por outro lado, com uma realocação que priorizou procedimentos com alta CMH, foi possível ganhar 140.444 USD (p < 0,001).


A atividade cirúrgica pode ser uma das atividades mais lucrativas para os hospitais, mas uma gestão custo-efetiva requer a compreensão de seu perfil de custos. A realocação do tempo não utilizado da sala cirúrgica de acordo com o MCH pode representar uma ferramenta simples, reprodutível e confiável para casos eletivos em lista de espera. Em nossa experiência, ajudou a melhorar a relação custo-benefício do conjunto operacional.


Salas de operação; Custo-benefício; Análise; Instalações de saúde; Custos de Cuidados de Saúde; Procedimentos Cirúrgicos Eletivos


1. I. Coulter, P. Herman, G Ryan, et al. Members of CERC Team. The challenge of determining appropriate care in the era of patient-centered care and rising health care costs J Health Serv Res Policy., 24 (2019), pp. 201-206

2. AR Seim, WS Sandberg Shaping the operating room and perioperative systems of the future: innovating for improved competitiveness Curr Opin Anaesthesiol., 23 (2010), pp. 765-771

3. J.E. Leister, J. Stausberg Comparison of cost accounting methods from different DRG systems and their effect on health care quality Health Policy., 74 (2005), pp. 46-55

4. N. Mihailovic, S. Kocic, M. Jakovljevic Review of Diagnosis-Related Group-Based Financing of Hospital Care Health Serv Res Manag Epidemiol., 3 (2016), Article 2333392816647892

5. A. Busato, G. von Below The implementation of DRG-based hospital reimbursement in Switzerland: A population-based perspective Health Res Policy Syst., 8 (2010), p. 31

6. D. La Regina, M. Di Giuseppe, M. Lucchelli, et al. Financial Impact of Anastomotic Leakage in Colorectal Surgery J Gastrointest Surg., 23 (2019), pp. 580-586

7. AH Rosenstein Fixed vs variable costs of hospital care JAMA., 282 (1999), p. 630

8. A. Macario Are your hospital operating rooms "efficient"? A scoring system with eight performance indicators Anesthesiology., 105 (2006), pp. 237-240

9. F Dexter, Rh Epstein, Rd Traub, et al. Making management decisions on the day of surgery based on operating room efficiency and patient waiting times Anesthesiology., 101 (2004), pp. 1444-1453

10. C. McIntosh, F. Dexter, R.H. Epstein The impact of service-specific staffing, case scheduling, turnovers, and first-case starts on anesthesia group and operating room productivity: a tutorial using data from an Australian hospital Anesth Analg., 103 (2006), pp. 1499-1516

11. A. Macario What does one minute of operating room time cost? J Clin Anesth., 22 (2010), pp. 233-236

12. L. Green Patient Flow: Reducing Delay in Healthcare Delivery Springer, Boston (2006)

13. A. Macario, T.S. Vitez, B. Dunn, et al. Where are the costs in perioperative care? Analysis of hospital costs and charges for inpatient surgical care Anesthesiology., 83 (1995), pp. 1138-1144

14. D.P. Strum, L.G. Vargas, J.H. May Surgical subspecialty block utilization and capacity planning: a minimal cost analysis model Anesthesiology., 90 (1999), pp. 1176-1185

15. F. Dexter, J. Ledolter, V. Tiwari, et al. Value of a scheduled duration quantified in terms of equivalent numbers of historical cases Anesth Analg., 117 (2013), pp. 205-210

16. F. Dexter, J.T. Blake, D.H. Penning, et al. Calculating a potential increase in hospital margin for elective surgery by changing operating room time allocations or increasing nursing staffing to permit completion of more cases: a case study Anesth Analg., 94 (2002), pp. 138-142

17. DC Krupka, WS Sandberg Operating room design and its impact on operating room economics Curr Opin Anaesthesiol., 19 (2006), pp. 185-191

18. A. Macario, F. Dexter, R.D. Traub Hospital profitability per hour of operating room time can vary among surgeons Anesth Analg., 93 (2001), pp. 669-675

19. F. Dexter, A. Macario, S.M. Cerone Hospital profitability for a surgeon’s common procedures predicts the surgeon’s overall profitability for the hospital J Clin Anesth., 10 (1998), pp. 457-463

20. C. Abicalaffe, J. Schafer Opportunities and Challenges of Value-Based Health Care: How Brazil Can Learn from U.S. Experience J Manag Care Spec Pharm., 26 (2020), pp. 1172-1175

21. R. Busse, A. Geissler, A. Aaviksoo, et al. Diagnosis related groups in Europe: moving towards transparency, efficiency, and quality in hospitals? BMJ., 346 (2013), p. f3197

22. F Mongelli, A Ferrario di Tor Vajana, M FitzGerald, et al. Open and Laparoscopic Inguinal Hernia Surgery: A Cost Analysis J Laparoendosc Adv Surg Tech A., 29 (2019), pp. 608-613

23. W. Quentin, D. Scheller-Kreinsen, M. Blümel, et al. Hospital payment based on diagnosis-related groups differs in Europe and holds lessons for the United States Health Aff (Millwood)., 32 (2013), pp. 713-723

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