The Real Cost of One Operating Room Minute
What does a minute of OR time actually cost? We break down the per-minute and per-hour numbers from the literature and the four places that cost quietly leaks out.
Everyone in perioperative leadership knows operating room time is expensive. The problem with "expensive" is that it does not fit on a budget line or justify an investment. To make decisions, you need a number — the cost of operating room time per minute and per hour — and you need to know where that cost quietly leaks out. This post gives you both: the per-minute estimates from the literature, what they include, and the four places the money goes.
Why "OR time is expensive" isn't specific enough
A vague sense that the OR is costly leads to vague action. A specific per-minute figure changes the conversation: it turns a 15-minute late start into a dollar amount, a slow turnover into a recurring line item, and an unfilled block into quantifiable lost capacity. The number is what lets you compare an efficiency investment against the waste it removes.
The catch is that any single figure is only as good as its definition — so let's be precise.
The per-minute estimates from the literature
The ~$37/minute figure (and what it includes)
The most-cited rigorous estimate comes from a 2018 JAMA Surgery cost analysis of California hospitals. It put the mean cost of OR time at $37.45 per minute in inpatient settings and $36.14 per minute in ambulatory settings — roughly $2,200 per hour. That figure covers direct costs (staff wages and benefits, supplies, equipment) and indirect overhead, but it does not include surgeon professional fees. Notably, teaching hospitals came in lower (about $29.88/minute) than non-teaching ones (about $38.29/minute).
Mean inpatient OR cost (about $2,200/hour), covering staff, supplies, and overhead but not surgeon fees; ambulatory was $36.14/min.
Childers & Maggard-Gibbons, JAMA Surgery, 2018
Why high-cost academic centers cite ~$150/minute
If you have seen much higher numbers, they are usually from high-cost urban academic centers and reflect a fuller or richer cost basis. A Lean turnover-improvement project at NYU Langone Health, for example, worked from an estimated cost of approximately $150 per minute of OR time at that institution. Both figures can be "right" — they describe different settings and cost definitions. The lesson is to anchor on a number that matches your facility rather than importing someone else's headline.
Translating minutes into annual dollars
The reason the per-minute figure matters is multiplication. At even the conservative ~$37/minute, a recurring 20-minute daily inefficiency in a single room — a late start here, a slow turnover there — is roughly $740 a day. Across a five-day week and a full year in one room, that is six figures of waste from a problem that feels, day to day, like "just a few minutes." Scale it across multiple rooms and the number becomes a strategic priority rather than an operational annoyance.
The four places that cost leaks out
Wasted OR minutes are not random. They concentrate in four buckets, each of which has its own playbook:
- Late first-case starts. The first case has the whole day to compound, so its minutes are the most expensive to lose. See first case on-time starts.
- Slow turnovers. The gap between cases, repeated all day, every room. See reducing turnover time.
- Day-of-surgery cancellations. A cancelled case strands staffed, already-paid-for time that is hard to backfill. See the cost of cancellations.
- Unfilled block time. Allocated capacity that goes unused is capacity you paid to staff and didn't sell. See reclaiming underutilized block time.
One number, four leaks
The per-minute cost is the multiplier; these four buckets are where the minutes go. Quantifying each in the same currency — dollars of staffed OR time — is what lets you rank them and attack the biggest one first.
How ORbit makes the cost of lost minutes visible in real time
Knowing OR time costs ~$37 a minute is useless if you cannot see where your minutes are going. ORbit ties the four leak points together on a median-based, facility-scoped view — late starts, turnover distributions, cancellations, and block utilization — so wasted minutes show up as a running total you can act on, not a surprise at quarter-end. We formalize that running total in lost-case scoring, which converts wasted minutes into the cases you could have done. To see what a minute is worth in your own ORs, take a look at your own data.
Frequently asked questions
How much does one minute of operating room time cost?
A 2018 JAMA Surgery analysis of California hospitals estimated mean OR cost at about $37.45 per minute in inpatient settings and $36.14 per minute in ambulatory settings — roughly $2,200 per hour — covering staff, supplies, and overhead but not surgeon professional fees. High-cost academic centers cite higher figures; one New York academic hospital estimated about $150 per minute.
Why do per-minute OR cost estimates vary so much?
Because they include different things and reflect different settings. A figure can include or exclude surgeon fees, anesthesia, implants, and indirect overhead, and a high-cost urban academic center looks very different from a community ASC. Use a number that matches your own setting and is explicit about what it covers.
Where does OR time cost leak out?
Four main places — late first-case starts, slow turnovers between cases, day-of-surgery cancellations that strand staffed time, and unfilled block time. Each converts directly into wasted, already-paid-for minutes, which is why small recurring inefficiencies add up to large annual dollars.