The Costs of Running an Orthopaedic Theatre Per Hour at a Tertiary Hospital in South Africa

Abstract

Background: In South African Hospitals, orthopaedic departments have an increasing burden of trauma to manage with limited resources. Operating theatre availability is an expensive scarce commodity and needs to be well managed to cope with the demands of trauma. Orthopaedic surgical theatres are known to be associated with higher costs than other disciplines due to the complexity and duration of the surgeries as well, in addition to costly implants. The South African healthcare system is under great financial strain as government cuts in healthcare expenditure are enforced by the poorly performing economy, the ravages of COVID-19, and load-shedding. For these reasons, careful financial planning and budgeting are required to optimize efficient operating theatre usage, and establishing an accurate costing model is critical to achieving these goals. At present, there is no established model for theatre costs in South Africa. This study aims to quantify the cost of running an orthopaedic theatre service at a tertiary-level government hospital to guide healthcare systems in economic decision-making. Methodology: Prospective Descriptive study where data Collection was performed in the orthopaedic theatre complex at Groote Schuur Hospital over two weeks in June 2017. Three theatres were audited over a total of 8 days over the two-week study period. The resources identified were consumables, medication, services, staff, medical gases, electricity, and water. In total 14 orthopaedic cases were observed. Information on the above usages from those surgeries was docu-mented and raw data was collected. Results: In total,  it was calculated that the cost of running the 3 theatres over the study period was R867 618.91, totaling R43 221.33 per hour. For individual theatres, the cost is thus R14 407.11 per hour (R240.11/min) per theatre (Excluding implants). Staff and human resources by far equated to the highest cost. A total of R86 7618.91 or R29917.89/hour was the calculated cost of staff over the study. period which was significantly higher than other expenses. Orthopaedic implants also ran a high cost at an average of R20 473.31 per case. Medical cases and anesthetic drugs were similarly expensive at R12 066.80 per hour. Conclusion: The cost of running orthopaedic theatres at a tertiary hospital is highly cost intensive at R43 221 per hour (2 500 USD/hour). Although there are limitations (small sample size over a short study period) it is an attempt at adding a monetary value to the cost of orthopaedic operating time in a state hospital, which has not been accurately quantified, not only in the literature but also on the management platforms around hospitals in South Africa. Understanding and identifying the cost of orthopaedic services is paramount. This will not only allow hospital management to manage resources more efficiently but also assist in forming and structuring an economic model for private sector hospitals as well as a possible national health service.