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Spinal anesthesia in a designated block bay for total joint arthroplasty: improving operating room efficiency
  1. Ryland Kagan1,
  2. Stephanie Zhao2,
  3. Andrew Stone2,
  4. Alicia J Johnson3,
  5. Thomas Huff1,
  6. Kathryn Schabel1,
  7. Glenn E Woodworth4 and
  8. Ryan MJ Ivie4
  1. 1Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon, USA
  2. 2School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
  3. 3Biostatistics and Design Program, Oregon Health & Science University, Portland, Oregon, USA
  4. 4Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA
  1. Correspondence to Dr Ryland Kagan, Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon, USA; kagan{at}


Background Creating highly efficient operating room (OR) protocols for total joint arthroplasty (TJA) is a challenging and multifactorial process. We evaluated whether spinal anesthesia in a designated block bay (BBSA) would reduce time to incision, improve first case start time and decrease conversion to general anesthesia (GA).

Methods Retrospective cohort study on the first 86 TJA cases with BBSA from April to December 2018, compared with 344 TJA cases with spinal anesthesia performed in the OR (ORSA) during the same period. All TJA cases were included if the anesthetic plan was for spinal anesthesia. Patients were excluded if circumstances delayed start time or time to incision (advanced vascular access, pacemaker interrogation, surgeon availability). Data were extracted and analyzed via a linear mixed effects model to compare time to incision, via a Wilcoxon rank-sum test to compare first case start time, and via a Fisher’s exact test to compare conversion to GA between the groups.

Results In the mixed effect model, the BBSA group time to incision was 5.37 min less than the ORSA group (p=0.018). The BBSA group had improved median first case start time (30.0 min) versus the ORSA group (40.5 min, p<0.0001). There was lower conversion to GA 2/86 (2.33%) in the BBSA group versus 36/344 (10.47%) in the ORSA group (p=0.018). No serious adverse events were noted in either group.

Conclusions BBSA had limited impact on time to incision for TJA, with a small decrease for single OR days and no improvement on OR days with two rooms. BBSA was associated with improved first case start time and decreased rate of conversion to GA. Further research is needed to identify how BBSA affects the efficiency of TJA.

  • anesthesia
  • conduction
  • methods
  • injections
  • spinal

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  • Contributors All authors have made substantial contributions to the conception and design of the work being submitted. SZ, AS specifically contributed the majority of the data acquisition, RK, AJJ and RI specifically contributed the majority of the interpretation of the data for the work. All authors have contributed to drafting the work, revising critically have given final approval of the version to be published. Additionally all authors are in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Oregon Health and Science University IRB - STUDY00019793: Block Bay Spinal Anesthesia for Total Joint Arthroplasty: A Retrospective Study of Efficiency and Safety.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. IRB approval will be sought to transfer data on a case-by-case basis, as the originally approved protocol did not cover data transfer to outside institutions.