By Melissa Kelly

Hospitals are under constant pressure to do more with less; more surgical volume, fewer staff, tighter margins. Everyone is being asked to move patients through the system faster without compromising care.

But one of the biggest drivers of whether that actually happens isn’t getting enough attention: what happens during surgeries in the operating room?
We tend to talk about recovery as something that starts after surgery. In reality, by the time a patient leaves the OR, a lot of their recovery trajectory is already set. And when surgeries don’t go as planned, the consequences are immediate — longer PACU stays, delayed discharges, and sometimes even ICU utilization.

From a business standpoint, those aren’t small issues. They add cost, reduce bed capacity, and flip the discharge process upside down. For the average large hospital system, these costs can easily add up to over $50 million every year.

The same preventable issues keep showing up
Two of the most common surgical challenges are:

1. Unintended hypothermia. Unintended hypothermia can result in increased blood loss which can then result in transfusions, cardiovascular events and decreased wound healing that can lead to surgical site infections. It also prevents the body from metabolizing drugs, including anesthetics, at a normal rate, causing the patient to take longer to wake up. All of these can result in a prolonged hospital stay for the patient and the additional costs associated with it.

2. Injuries or complications related to patient positioning and securement. This is especially a risk in longer or robotic cases where patients are tilted or in the Trendelenburg position where securement is critical. If a patient isn’t well-secured, even small shifts can lead to injury, discomfort, nerve issues, or delayed mobility afterward.

Anyone who’s worked in post-operative care knows that if a patient can’t mobilize when expected, everything slows down. What was supposed to be a same-day or next-day discharge can easily turn into an additional inpatient day and maybe more than one day.

That’s not just a clinical issue, it’s a capacity issue. One delay impacts the next patient, and the next, and so on.

Where things break down: too many trade-offs in the OR
Clinicians are aware of these challenges, but managing them isn’t always straightforward.

In many cases, they have to balance competing priorities: maintain normothermia, despite limited access or secure the patient, knowing equipment and positioning constraints might inhibit active warming measures. Surgical teams make it work because OR clinicians are incredibly resourceful. But piecing together multiple tools to solve conflicting priorities introduces variability. And variability lends itself to inconsistent outcomes.

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