The cost effectiveness of implementing picture archiving and communication systems (PACS) in the operating room

Background: Intraoperative access to radiographic images is essential for the accurate diagnosis, operative planning and surgical treatment of many musculoskeletal conditions. Traditionally, hardcopy radiographs have been readily available for this purpose. Recently, however, hardcopy radiographs have become less accessible because many hospitals have transitioned to digitally-based picture archiving and communication systems (PACS). Typically, PACS is available in hospital clinics, emergency rooms, and radiology departments but not, as in our institution, in the operating room. The purpose of this study was to determine the merits of implementing and having access to PACS in the operating room. Methods: All hardcopy radiographs generated solely for use in orthopaedic surgery cases at our institution were prospectively tracked for 3 months. The annualized costs associated with these hardcopy images (film, production, storage, technical time) were compared with the projected cost of acquiring, mounting, and maintaining PACS monitors in the orthopaedic surgery operating room. Results: Comparative cost analysis determined that the initial 12-month cost for orthopaedic surgery PACS in the operating room would be realized at 9 months after implementation; the projected PACS net savings for our institution would be approximately $500,000 at 10 years after implementation. Conclusions: In addition to improved efficiency in patient care, a clear cost benefit exits of implementing PACS in the orthopaedic surgery operating room.