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Is after-hours orthopaedic surgery associated with adverse outcomes? A prospective comparative study
William M Ricci1, Bethany Gallagher, Angel Brandt
1Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO 63110, USA. ricciw@wustl.edu
The Journal of Bone and Joint Surgery. American Volume
|September 3, 2009
Summary
After-hours surgery for tibial and femoral fractures shows similar healing and radiation exposure. However, after-hours femoral procedures led to more hardware removal, suggesting potential benefits from increased daytime operating time.
Area of Science:
- Orthopaedic surgery
- Trauma care
- Surgical outcomes
Background:
- Fracture treatment can occur outside standard hours, potentially under suboptimal conditions.
- The impact of after-hours surgery on fracture fixation outcomes is not well-understood.
- This study investigates outcomes of intramedullary nail fixation for tibial and femoral shaft fractures based on surgical timing.
Purpose of the Study:
- To compare outcomes of intramedullary nail fixation for tibial and femoral shaft fractures performed during daytime versus after-hours.
- To evaluate the influence of surgical timing on fracture healing, complications, operative time, and radiation exposure.
- To identify specific risks associated with after-hours fracture fixation.
Main Methods:
- A prospective, multicenter, nonrandomized study included 203 patients with tibial or femoral shaft fractures (OTA 32 or 42).
- Patients were categorized into daytime (6 AM - 4 PM) and after-hours (4 PM - 6 AM) surgical groups.
- Data on fracture healing, complications, operative time, and fluoroscopy time were collected for femoral antegrade/retrograde and tibial nail fixation with reaming.
Main Results:
- Fracture healing rates were comparable between daytime and after-hours groups for both bone types.
- Operative times were shorter for after-hours procedures, but this was not an independent predictor of operative time.
- Radiation exposure was similar; however, after-hours surgery was linked to more unplanned reoperations and a higher rate of painful hardware removal in femoral fractures.
Conclusions:
- After-hours intramedullary nail fixation for tibial and femoral fractures demonstrates similar nonunion, infection, and radiation exposure rates.
- After-hours femoral nailing showed an increased need for painful hardware removal, potentially due to technical factors or shorter operative times.
- Optimizing daytime operating room availability for orthopaedic trauma may reduce minor complication rates.