Predicting the unpredictable: A retrospective cohort study to determine the accuracy of estimated operative duration in orthopedic surgery

doi:10.5312/wjo.v17.i6.120229

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Publication Name

World Journal of Orthopedics

ISSN

2218-5836

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Orthop. Jun 18, 2026; 17(6): 120229
Published online Jun 18, 2026. doi: 10.5312/wjo.v17.i6.120229

Predicting the unpredictable: A retrospective cohort study to determine the accuracy of estimated operative duration in orthopedic surgery

Ammar K Alomran, Manar Alossaif, Ammar Abusultan, Hadi Alhamal, Dalal Albaiji, Lama Alkhunaizi, Sarah Alhaddad, Abdulrazzag Alharbi

Ammar K Alomran, Manar Alossaif, Hadi Alhamal, Sarah Alhaddad, Abdulrazzag Alharbi, Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia

Ammar Abusultan, Department of Orthopedic Surgery, Lille University Hospital, Lille 59037, France

Dalal Albaiji, Department of Orthopedic Surgery, Dammam Medical Complex, Dammam 32246, Saudi Arabia

Lama Alkhunaizi, Department of Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran 34451, Ash Sharqīyah, Saudi Arabia

Author contributions: Alomran AK was responsible for supervision, project administration, writing review and editing; Alossaif M and Alhamal H did the investigation, writing original draft, visualization; Abusultan A did the methodology and conceptualization; Albaiji D, Alkhunaizi L, Alharbi A, Alhaddad S were responsible for investigation and data curation.

AI contribution statement: During the preparation of this work, the authors used Generative AI tools (ChatGPT, OpenAI-version 5.1) solely to enhance the grammar, clarity, and readability of the manuscript. All study ideas, methodology, data collection, data analysis, interpretation of findings, and conclusions were fully developed by the authors without the influence of AI tools. The authors have reviewed and approved the final version of the manuscript and take complete responsibility for its content.

Institutional review board statement: It has been approved by the Institutional Review Board of Imam Abdulrahman Bin Faisal University, No. IRB-2023-01-250.

Informed consent statement: In accordance with applicable ethical guidelines and institutional policies, the requirement for informed consent was waived, as the study involved analysis of existing data and posed minimal risk to participants. All data were handled in a manner that ensured confidentiality and anonymity. The study protocol was reviewed and approved by the appropriate Institutional Review Board/Ethics Committee, which granted the waiver of informed consent.

Conflict-of-interest statement: The authors deny any conflict of interest.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement- checklist of items.

Data sharing statement: Not applicable.

Corresponding author: Hadi Alhamal, MBBS, Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Bashar Ibn Burd Street, Al Aqrabiyah, Dammam 31441, Saudi Arabia. hadialhamal@gmail.com

Received: February 26, 2026
Revised: March 30, 2026
Accepted: May 11, 2026
Published online: June 18, 2026
Processing time: 117 Days and 11.5 Hours

Abstract

BACKGROUND

Annually, millions of major surgical procedures are performed worldwide, and precise estimation of operative duration is crucial for surgical planning and operating room (OR) scheduling. Both overestimation and underestimation of procedure time can reduce the efficiency of OR utilization. Therefore, this study investigated the prevalence and factors associated with overestimation and underestimation of the duration of orthopedic surgeries.

AIM

To assess the accuracy of estimated operative duration for orthopedic surgeries by determining the prevalence of overestimation and underestimation and identifying factors associated with these discrepancies.

METHODS

This retrospective, single-center cohort study included patients undergoing orthopedic surgeries at a tertiary hospital. Data were collected from medical records before and after each procedure. Patient demographics, medical status, diagnosis, anesthesia start and end times, estimated and actual surgery durations, and length of hospital stay were analyzed.

RESULTS

Overall, 209 operations were reviewed. The patients’ mean age was 34.8 ± 21.1 years, with 51.2% being male. The mean duration of anesthesia was 3.60 hours, while the mean operating time was 4.37 hours. Underestimation of operative duration by more than 30 minutes was observed in 46.4% of the patients, while the operative time was overestimated for rest of the operations. Anesthesia duration and patient sex were key factors influencing the operative time.

CONCLUSION

In conclusion, overestimation and underestimation of scheduled operation times represent a widespread concern that warrants further attention. Patient comorbidities are the most common factors influencing operation duration, emphasizing the importance of considering patient-specific factors, individualized scheduling, and operation time estimation on a case-by-case basis.

Keywords: Operating room; Operation time; Orthopedic surgeon; Orthopedic surgery; Surgery

Core Tip: Accurate prediction of surgical duration is essential for efficient operating room (OR) scheduling. This study found that both overestimation and underestimation of orthopedic surgery times are common, with surgery times being underestimated for nearly half of all procedures. Patient comorbidities were identified as a key factor influencing operative duration, highlighting the need for individualized, case-based time estimation to improve OR efficiency and surgical planning.