Background: Operating room delays decrease health care system efficiency and increase hospital costs. Data on delays in a multihospital system are sparse.

Purpose: In an effort to improve our operating room efficiency, we investigated operating room delays, the causes and the impending financial impact.

Methods: A retrospective analysis on first case-of-the-day surgeries at three hospitals during 2013 was conducted. Delays were defined as in-room time being after scheduled surgery start time. Length of delay and causes were recorded. Patient demographics, body mass index, hospital facility, total number of procedures, provider specialty and time of patient arrival were incorporated into a logistic regression model to identify significant variables. Hosmer-Lemeshow was used to measure goodness-of-fit and predictive power. Cost was calculated using published estimates.

Results: 5,607 cases were examined and 88% were delayed. Surgeons (21%), anesthesiologists (6.17%), patients (5.42%), staff (3.60%), facility (2.10%) and other (2.35%) were identified as causes. Mean time for patient arrival to surgery was 104.57 min. Mean time between arrival and room placement was 127.38 min. The average delay time from scheduled surgery start was 24.26 min. Logistic regression identified hospital facility (P < 0.0001), surgical specialty (P < 0.0001), patient age (P = 0.0004) and late patient arrival (P = 0.0005) as significant predictors of delay. Operating room delays were responsible for $444,074 in lost revenue.

Conclusion: In our study, 88% of first start cases were delayed, the majority of which were caused by the surgeon. However, hospital facility, surgical subspecialty, patient age and arrival time also significantly affected delays. Correction of operating room delays can significantly reduce hospital costs.