•  
  •  
 

Abstract

Optimal utilization of the operating room (OR) is a crucial element in improving the efficiency of surgical services and hospital performance. This scoping review aimed to identify and map the factors influencing OR utilization based on recent scientific literature. We conducted a scoping review using the Population–Concept–Context (PCC) framework and reported it according to the PRISMA-ScR guidelines. We systematically searched PubMed, Scopus, and ScienceDirect for articles published between 2015 and 2025. Eligible studies were screened, and information on study characteristics and reported determinants of OR utilization was extracted and summarized descriptively. Forty studies were included. The reported determinants clustered into two broad domains: patient-related factors including age, Body Mass Index (BMI), American Society of Anesthesiologists (ASA) status, medical history, preoperative readiness, and financial conditions; and hospital-related factors including scheduling systems, waiting times, staff preparedness, resource availability, Post-Anesthesia Care Unit (PACU) and Intensive Care Unit (ICU) bed capacity, procedure complexity, and technology utilization. Across different settings, hospital and organizational factors showed a more consistent association with OR utilization than patient characteristics. The findings suggest that how ORs are managed and coordinated matters more for utilization than who the patients are. Strengthening scheduling, teamwork, and operational processes may therefore be key to improving OR utilization.

References

Abbou, B. et al. (2022) ‘Optimizing Operation Room Utilization—A Prediction Model’, Big Data and Cognitive Computing, 6(3), p. 76. Available at: https://doi.org/10.3390/bdcc6030076.

Abedini, A., Ye, H. and Li, W. (2016) ‘Operating Room Planning under Surgery Type and Priority Constraints’, Procedia Manufacturing, 5, pp. 15–25. Available at: https://doi.org/10.1016/j.promfg.2016.08.005.

American Society of Anesthesiologists (2020) Statement on ASA Physical Status Classification System. Available at: https://www.asahq.org/standards-and-practice-parameters/statement-on-asa-physical-status-classification-system.

Al Amin, M., Baldacci, R. and Kayvanfar, V. (2025) ‘A comprehensive review on operating room scheduling and optimization’, Operational Research, 25(1), p. 3. Available at: https://doi.org/10.1007/s12351-024-00884-z.

Asmal, I.I., Keerath, K. and Cronjé, L. (2019) ‘An audit of operating theatre utilisation and day-of-surgery cancellations at a regional hospital in the Durban metropole’, South African Medical Journal, 109(10), p. 765. Available at: https://doi.org/10.7196/SAMJ.2019.v109i10.13815.

Balzer, C. et al. (2017) ‘Timeliness of Operating Room Case Planning and Time Utilization: Influence of First and To-Follow Cases’, Frontiers in Medicine, 4. Available at: https://doi.org/10.3389/fmed.2017.00049.

Barnea, R. et al. (2019) ‘Analyzing Operating Room Utilization in a Private Medical Center in Israel.’, The Israel Medical Association journal : IMAJ, 21(10), pp. 644–648. Available at: http://www.ncbi.nlm.nih.gov/pubmed/31599503.

Cahan, E.M. et al. (2021) ‘Influence of team composition on turnover and efficiency of total hip and knee arthroplasty’, The Bone & Joint Journal, 103-B(2), pp. 347–352. Available at: https://doi.org/10.1302/0301-620X.103B2.BJJ-2020-0170.R2.

Çelik, B., Gul, S. and Çelik, M. (2023) ‘A stochastic programming approach to surgery scheduling under parallel processing principle’, Omega, 115, p. 102799. Available at: https://doi.org/10.1016/j.omega.2022.102799.

Clavel, D. et al. (2020) ‘A Decision Support System for Elective Surgery Scheduling under Uncertain Durations’, Applied Sciences, 10(6), p. 1937. Available at: https://doi.org/10.3390/app10061937.

Connolly, J. et al. (2023) ‘Postoperative Outcomes and Resource Utilization Following Open vs Endoscopic Far Lateral Lumbar Discectomy’, International Journal of Spine Surgery, 17(3), pp. 350–355. Available at: https://doi.org/10.14444/8443.

Da’ar, O.B. and Al-Mutairi, T. (2018) ‘How do patient demographics, time-related variables, reasons for cancellation, and clinical procedures affect frequency of same-day operating room surgery cancelation? A maximum likelihood method’, BMC Health Services Research, 18(1), p. 454. Available at: https://doi.org/10.1186/s12913-018-3247-y.

Díaz-López, D.M. et al. (2018) ‘A simulation-optimization approach for the surgery scheduling problem: a case study considering stochastic surgical times’, International Journal of Industrial Engineering Computations, pp. 409–422. Available at: https://doi.org/10.5267/j.ijiec.2018.1.002.

Edelman, E.R. et al. (2017) ‘Improving the Prediction of Total Surgical Procedure Time Using Linear Regression Modeling’, Frontiers in Medicine, 4. Available at: https://doi.org/10.3389/fmed.2017.00085.

Feleke, M.G., Chichiabellu, T.Y. and Ayalew, T.L. (2022) ‘Magnitude and reasons of surgery cancellation among elective surgical cases in Wolaita Sodo University Comprehensive Specialized Hospital, Southern Ethiopia, 2021’, BMC Surgery, 22(1), p. 300. Available at: https://doi.org/10.1186/s12893-022-01749-y.

Foley, C. et al. (2021) ‘American Society of Anesthesiologists Physical Status Classification as a reliable predictor of postoperative medical complications and mortality following ambulatory surgery: an analysis of 2,089,830 ACS-NSQIP outpatient cases’, BMC Surgery, 21(1), p. 253. Available at: https://doi.org/10.1186/s12893-021-01256-6.

Ford, S. et al. (2021) ‘Utilisation of paediatric surgical theatres at the Chris Hani Baragwanath Academic Hospital, Johannesburg’, South African Journal of Child Health, 15(4), pp. 185–188. Available at: https://doi.org/10.7196/SAJCH.2021.v15i4.1774.

Garbey, M. et al. (2017) ‘Multiscale Modeling of Surgical Flow in a Large Operating Room Suite: Understanding the Mechanism of Accumulation of Delays in Clinical Practice’, Procedia Computer Science, 108, pp. 1863–1872. Available at: https://doi.org/10.1016/j.procs.2017.05.228.

Geldmaker, L.E. et al. (2022) ‘Analysis of fixed and variable operating room (or) time point efficiency in partial nephrectomies: open versus robotic-assisted’, Journal of Robotic Surgery, 17(3), pp. 853–858. Available at: https://doi.org/10.1007/s11701-022-01477-8.

Grewal, S., Oosterling, S.J. and van Egmond, M. (2021) ‘Surgery for Colorectal Cancer: A Trigger for Liver Metastases Development? New Insights into the Underlying Mechanisms.’, Biomedicines, 9(2). Available at: https://doi.org/10.3390/biomedicines9020177.

Hamid, Mahdi et al. (2019) ‘Scheduling elective patients based on sequence-dependent setup times in an open-heart surgical department using an optimization and simulation approach’, SIMULATION, 95(12), pp. 1141–1164. Available at: https://doi.org/10.1177/0037549718811591.

Hariharan, S. and Chen, D. (2015) ‘Costs and Utilization of Operating Rooms in a Public Hospital in Trinidad, West Indies’, The Permanente Journal, 19(4). Available at: https://doi.org/10.7812/TPP/14-183.

Hatch, J.L. et al. (2017) ‘The influence of obesity on operating room time and perioperative complications in cochlear implantation’, World Journal of Otorhinolaryngology - Head and Neck Surgery, 3(4), pp. 231–234. Available at: https://doi.org/10.1016/j.wjorl.2017.12.004.

Hoffman, C.R. et al. (2019) ‘Operating room first case start times: a metric to assess systems-based practice milestones?’, BMC Medical Education, 19(1), p. 446. Available at: https://doi.org/10.1186/s12909-019-1886-2.

Van Huele, C. and Vanhoucke, M. (2015) ‘Operating theatre modelling: integrating social measures’, Journal of Simulation, 9(2), pp. 121–128. Available at: https://doi.org/10.1057/jos.2014.32.

Institute for Health Metrics and Evaluation (2024) Global Burden of Disease 2021: Findings from the GBD 2021 Study. Seattle, WA. Available at: https://ghdx.healthdata.org/record/ihme-data/gbd-2021-burden-by-risk-1990-2021.

Jiang, W. and Carvalho, D. (2022) ‘COVID-19 effects on operating room cancellations at a pediatric tertiary care hospital: A retrospective cohort study’, Annals of Medicine & Surgery, 81. Available at: https://doi.org/10.1016/j.amsu.2022.104427.

Kashanian, K. et al. (2025) ‘Optimizing Operating Room Efficiency for Primary Hip and Knee Arthroplasty Using Performance Benchmarks’, Arthroplasty Today, 31, p. 101590. Available at: https://doi.org/10.1016/j.artd.2024.101590.

Kumar, M. and Malhotra, S. (2017) ‘Reasons for delay in turnover time in operating room- an observational study’, Bangladesh Journal of Medical Science, 16(2), pp. 245–251. Available at: https://doi.org/10.3329/bjms.v16i2.27473.

Lim, G. et al. (2023) ‘Obstetric operating room staffing and operating efficiency using queueing theory’, BMC Health Services Research, 23(1), p. 1147. Available at: https://doi.org/10.1186/s12913-023-10143-0.

Lowndes, B. et al. (2016) ‘Impact of patient factors on operative duration during laparoscopic cholecystectomy: evaluation from the National Surgical Quality Improvement Program database’, The American Journal of Surgery, 212(2), pp. 289–296. Available at: https://doi.org/10.1016/j.amjsurg.2016.01.024.

Lu, C.-H. et al. (2016) ‘Faster extubation time with more stable hemodynamics during extubation and shorter total surgical suite time after propofol-based total intravenous anesthesia compared with desflurane anesthesia in lengthy lumbar spine surgery’, Journal of Neurosurgery: Spine, 24(2), pp. 268–274. Available at: https://doi.org/10.3171/2015.4.SPINE141143.

MacMillan, L. et al. (2025) ‘What affects operating room turnover time? A systematic review and mapping of the evidence’, Surgery, 181, p. 109263. Available at: https://doi.org/10.1016/j.surg.2025.109263.

Meara, J.G. et al. (2015) ‘Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development’, The Lancet, 386(9993), pp. 569–624. Available at: https://doi.org/10.1016/S0140-6736(15)60160-X.

Morgenegg, R. et al. (2018) ‘Discrepancies Between Planned and Actual Operating Room Turnaround Times at a Large Rural Hospital in Germany’, Sultan Qaboos University Medical Journal, 17(4), pp. 418–423. Available at: https://doi.org/10.18295/squmj.2017.17.04.007.

Mousavi, S.R., Sepehri, M. and Najafi, S.E. (2024) ‘A Framework for Improving Patient Satisfaction by Reducing the Length of Stay in The Operation Suite Using the Combined DEMATEL-ANP Model’, Decision Making: Applications in Management and Engineering, 7(2), pp. 197–220. Available at: https://doi.org/10.31181/dmame722024882.

Munn, Z. et al. (2018) ‘Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach’, BMC Medical Research Methodology, 18(1), p. 143. Available at: https://doi.org/10.1186/s12874-018-0611-x.

Pappada, S.M. et al. (2022) ‘Contributing Factors to Operating Room Delays Identified from an Electronic Health Record: A Retrospective Study’, Anesthesiology Research and Practice. Edited by G. Minervini, 2022, pp. 1–7. Available at: https://doi.org/10.1155/2022/8635454.

Park, J.-B. et al. (2025) ‘Development of Predictive Model of Surgical Case Durations Using Machine Learning Approach’, Journal of Medical Systems, 49(1), p. 8. Available at: https://doi.org/10.1007/s10916-025-02141-y.

Pasquer, A. et al. (2024) ‘Operating room organization and surgical performance: a systematic review’, Patient Safety in Surgery, 18(1), p. 5. Available at: https://doi.org/10.1186/s13037-023-00388-3.

Pridgeon, M. and Proudlove, N. (2022) ‘Getting Going on Time: Reducing Neurophysiology Set-up Times in Order to Contribute to Improving Surgery Start and Finish Times’, BMJ open quality, 11(3). Available at: https://doi.org/10.1136/bmjoq-2021-001808.

Roberts, H.W. et al. (2018) ‘Time and motion studies of National Health Service cataract theatre lists to determine strategies to improve efficiency’, British Journal of Ophthalmology, 102(9), pp. 1259–1267. Available at: https://doi.org/10.1136/bjophthalmol-2017-310452.

Rose, J. et al. (2015) ‘Estimated need for surgery worldwide based on prevalence of diseases: a modelling strategy for the WHO Global Health Estimate’, The Lancet Global Health, 3, pp. S13–S20. Available at: https://doi.org/10.1016/S2214-109X(15)70087-2.

Ryan, D. et al. (2024) ‘Specific Factors Affecting Operating Room Efficiency: An Analysis of Case Time Estimates’, The Journal of Hand Surgery, 49(5), pp. 492.e1-492.e9. Available at: https://doi.org/10.1016/j.jhsa.2022.08.025.

Saadouli, H. et al. (2015) ‘A stochastic optimization and simulation approach for scheduling operating rooms and recovery beds in an orthopedic surgery department’, Computers & Industrial Engineering, 80, pp. 72–79. Available at: https://doi.org/10.1016/j.cie.2014.11.021.

Saporito, A. et al. (2023) ‘Contribution margin per hour of operating room to reallocate unutilized operating room time: a cost-effectiveness analysis’, Brazilian Journal of Anesthesiology (English Edition), 73(3), pp. 243–249. Available at: https://doi.org/10.1016/j.bjane.2021.03.024.

Schouten, A.M. et al. (2023) ‘Operating Room Performance Optimization Metrics: a Systematic Review’, Journal of Medical Systems, 47(1), p. 19. Available at: https://doi.org/10.1007/s10916-023-01912-9.

Segal, J.B. et al. (2022) ‘Factors Associated With Overuse of Health Care Within US Health Systems’, JAMA Health Forum, 3(1), p. e214543. Available at: https://doi.org/10.1001/jamahealthforum.2021.4543.

Sibhatu, M.K. et al. (2024) ‘Surgical System Efficiency and Operative Productivity in Public and Private Health Facilities in Ethiopia: A Cross-Sectional Evaluation’, Global Health: Science and Practice, 12(1), p. e2200277. Available at: https://doi.org/10.9745/GHSP-D-22-00277.

Souders, C.P. et al. (2017) ‘Reducing Operating Room Turnover Time for Robotic Surgery Using a Motor-Racing Pit-Stop Model’, World J Surg, 41(8), pp. 1943–1949. Available at: https://doi.org/https://doi.org/10.1007/s00268-017-3936-4.

Stavrides, K.P. et al. (2023) ‘Accurate Operative Time Prediction in Thyroid Surgery: A Rural Tertiary Care Facility Experience’, Ear, Nose & Throat Journal, 102(8), pp. 498–503. Available at: https://doi.org/10.1177/01455613211016702.

Tan, A.L. et al. (2019) ‘Risk factors and reasons for cancellation within 24 h of scheduled elective surgery in an academic medical centre: A cohort study’, International Journal of Surgery, 66, pp. 72–78. Available at: https://doi.org/10.1016/j.ijsu.2019.04.009.

Tricco, A.C. et al. (2018) ‘PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation’, Annals of Internal Medicine, 169(7), pp. 467–473. Available at: https://doi.org/10.7326/M18-0850.

Vahwere, B.M. et al. (2021) ‘Prevalence and factors associated with cancellation and deferment of elective surgical cases at a rural private tertiary hospital in Western Uganda: a cross sectional study’, Pan African Medical Journal, 39. Available at: https://doi.org/10.11604/pamj.2021.39.139.24667.

Vladu, A. et al. (2024) ‘Enhancing Operating Room Efficiency: The Impact of Computational Algorithms on Surgical Scheduling and Team Dynamics’, Healthcare, 12(19), p. 1906. Available at: https://doi.org/10.3390/healthcare12191906.

Wang, L. et al. (2021) ‘Operating room planning and scheduling for outpatients and inpatients: A review and future research’, Operations Research for Health Care, 31, p. 100323. Available at: https://doi.org/10.1016/j.orhc.2021.100323.

Wong, D.J.N. et al. (2018) ‘Cancelled operations: a 7-day cohort study of planned adult inpatient surgery in 245 UK National Health Service hospitals’, British Journal of Anaesthesia, 121(4), pp. 730–738. Available at: https://doi.org/10.1016/j.bja.2018.07.002.

Yamuragiye, A. et al. (2020) ‘Improving starting time in operating rooms of a tertiary hospital in Rwanda: a quality improvement project’, Rwanda Journal of Medicine and Health Sciences, 2(3), p. 289. Available at: https://doi.org/10.4314/rjmhs.v2i3.13.

Yuniartha, D.R. et al. (2023) ‘Adapting duration categorical value to accommodate duration variability in a next-day operating room scheduling’, Informatics in Medicine Unlocked, 37, p. 101180. Available at: https://doi.org/10.1016/j.imu.2023.101180.

Zhang, E.J. et al. (2024) ‘Scaling performance frontiers across multiple perioperative services’, Perioperative Care and Operating Room Management, 35, p. 100407. Available at: https://doi.org/10.1016/j.pcorm.2024.100407.

Bahasa Abstract

Utilisasi kamar operasi (OR) yang optimal merupakan elemen penting dalam meningkatkan kinerja pelayanan bedah dan kinerja rumah sakit. Scoping review ini bertujuan untuk mengidentifikasi dan memetakan faktor-faktor yang memengaruhi utilisasi kamar operasi berdasarkan literatur ilmiah terbaru. Scoping review dilakukan menggunakan kerangka Population–Concept–Context (PCC) dan dilaporkan sesuai pedoman PRISMA-ScR. Pencarian literatur dilakukan secara sistematis pada PubMed, Scopus, dan ScienceDirect untuk artikel yang diterbitkan antara tahun 2015-2025. Studi yang memenuhi kriteria diseleksi, dan data mengenai karakteristik studi serta determinan utilisasi OR diekstraksi dan diringkas secara deskriptif. Sebanyak 40 studi disertakan. Faktor-faktor yang teridentifikasi dikelompokkan ke dalam dua domain utama, yaitu faktor terkait pasien (usia, indeks massa tubuh, status American Society of Anesthesiologists (ASA), riwayat medis, kesiapan praoperatif, dan kondisi finansial) serta faktor terkait rumah sakit (sistem penjadwalan, waktu tunggu, kesiapan staf, ketersediaan sumber daya, kapasitas tempat tidur Post-Anesthesia Care Unit (PACU) and Intensive Care Unit (ICU), kompleksitas prosedur, dan pemanfaatan teknologi). Di berbagai konteks, faktor organisasional rumah sakit lebih konsisten berhubungan dengan variasi utilisasi OR dibandingkan karakteristik pasien. Utilisasi kamar operasi lebih dipengaruhi oleh pengelolaan dan koordinasi sistem daripada karakteristik pasien semata. Penguatan penjadwalan, kerja tim, dan proses operasional menjadi kunci peningkatan utilisasi OR.

Download

Share

COinS
 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.