Cost effectiveness of laminar flow systems for total shoulder arthroplasty: Filtering money from the OR?

Daniel E. Davis, Benjamin Zmistowski, Joseph A. Abboud, Surena Namdari

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: Laminar flow ventilation systems were developed to reduce surgical contamination in joint arthroplasty to avoid periprosthetic joint infection (PJI). The goals of this study are to evaluate the cost-effectiveness and economic viability of installing and maintaining a laminar flow system in an operating room. Methods: A Monte Carlo simulation was used to evaluate the cost effectiveness of laminar flow. The variables included were cost to treat PJI, incidence of PJI, cost of laminar flow, years of operating room use, and arthroplasty volume as the dependent variable. Results: Laminar flow would be financially-justified when 1,217 (SD: 319) TSA cases are performed annually with assumed 10% reduction in PJI from laminar flow and 487 (SD: 127) with assumed 25% reduction. In a high volume OR, laminar flow costs $25.24 per case (assuming 10% reduction) and $8.24 per case (assuming 25% reduction). Laminar flow would need to reduce the incidence of PJI by 35.1% (SD: 9.1) to be a cost-effective strategy. Conclusion: This analysis demonstrates the substantial arthroplasty volume and large reduction in PJI rates required to justify the installation and maintenance costs of this technology. This high cost of implementation should be considered prior to installing laminar flow systems.

Original languageEnglish
Pages (from-to)38-43
Number of pages6
JournalArchives of Bone and Joint Surgery
Issue number1
StatePublished - Jan 1 2020


  • Cost effectiveness
  • Laminar flow
  • Laminar flow cost effectiveness
  • Laminar flow efficacy
  • Sensitivity analysis
  • Total shoulder arthroplasty


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