Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Clinical Research

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

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


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