Operative Efficiency in Military Total Joint Arthroplasty Is Superior at an External Resource Sharing Agreement Facility as Compared to a Military Treatment Facility

• Published in: Military medicine 2024-09
• Main Authors: Fellows, Kenneth J, Carmack, David, Cameron, Joshuea, Hope, Donald, Cognetti, Daniel J
• Format: Article
• Language: English
• ISSN: 0026-4075; 1930-613X; 1930-613X
• DOI: 10.1093/milmed/usae426

Surgeries within the Military Health System (MHS) are often performed by military physicians at External Resource Sharing Agreement (ERSA) hospitals to offload the operative demand at Military Treatment Facilities (MTFs). These agreements allow physicians flexibility in selecting where to treat military service members and other TRICARE beneficiaries. However, there is a paucity of military orthopedic literature comparing ERSA hospitals and MTFs. The objective of this study is to compare operative volume, efficiency, and orthopedic resident operative experience between an ERSA hospital and an MTF in military arthroplasty. A retrospective chart review was conducted for all surgeries performed between October 1, 2022 and July 31, 2023 by three military arthroplasty-trained surgeons at an MTF and two associated ERSA hospitals (denoted as ERSA-A and ERSA-B). Details recorded include spinal time-out time, spinal end time, in-room time, case start time, case stop time, and out-of-room time. These were used to calculate the total time in room (out-of-room time minus in-room time), case time (case stop time minus case start time), extra time in room (total time in room minus case time), and time between cases (in-room time minus out-of-room time of previous case). Lastly, we compared the average daily case volume and operative time between the facilities. Only primary joint replacements with properly documented time stamps were included in the efficiency analysis. Continuous variables were assessed for normality by the Shapiro-Wilk test. Non-normal data are presented as the median and interquartile range (IQR) and were analyzed using the Mann-Whitney U test (for two group comparisons) or the Kruskal-Wallis test (three or more groups) with Dwass-Steel-Chritchlow-Fligner pairwise comparisons. The associations between categorical variables were analyzed using the chi-squared test. Significance was set to P