The decline of elective operating at major trauma centres
A Memarzadeh1, H Taki1, E K Tissingh1
1Cambridge University Hospitals NHS Foundation Trust , UK.
Insights
The England major trauma network
Area of Science:
- Orthopaedic surgery
- Trauma care systems
Background:
- Major trauma is a significant cause of death in young adults.
- England established a major trauma network in 2012 to centralize care.
- This network aimed to improve outcomes for multiply injured patients.
Purpose of the Study:
- To compare lower limb arthroplasty volumes before and after the trauma network's inception.
- To analyze the impact on major trauma centres (MTCs) versus non-MTCs.
Main Methods:
- Utilized National Joint Registry data for hip and knee arthroplasties.
- Compared data from the two years pre- and post-network activation.
- Stratified analysis by unit type (MTCs vs. non-MTCs).
Main Results:
- Overall lower limb arthroplasties increased by 5.5%.
- Non-MTCs showed an increasing trend in procedures.
- MTCs experienced a 13.6% reduction in lower limb arthroplasties (p<0.01).
Conclusions:
- The major trauma network correlated with a decrease in lower limb arthroplasties at MTCs.
- Further research is needed on the impact on surgical training and hospital finances.
Abstract:
INTRODUCTION Major trauma is a leading cause of death in those aged under 40 years. In order to improve the care for multiply injured patients, the major trauma network was activated in April 2012 in England. Its goal was to link all district hospitals to major trauma centres (MTCs) and allow for rapid transfer of patients. Anecdotally, this has affected elective orthopaedic operating at MTCs. The aim of this study was to compare the number of lower limb arthroplasty procedures performed before and after the establishment of the trauma network. METHODS Data on hip and knee arthroplasties in England during the two years prior to and the two years following the introduction of the trauma network were obtained from the National Joint Registry. These were broken down by type of unit (MTCs vs non-MTCs). Differences between the number of hip and knee arthroplasties undertaken in the two time periods were analysed. The chi-squared test was used to assess statistical significance. RESULTS The total number of lower limb arthroplasties increased after the activation of the trauma network by 5.5% (from 211,453 to 223,119). When stratifying the data by type of unit, this increasing trend was present for non-MTCs; however, in MTCs, a reduction occurred: the number reduced by 13.6% (from 13,492 to 11,657). This reversal of trend was seen in both hip and knee procedures independently (both p<0.01). CONCLUSIONS The introduction of the trauma network has led to a reduction in the total number of lower limb arthroplasty procedures performed in MTCs. Various reasons have been postulated for this but its impact on surgical training and hospital finances must be scrutinised in future research.
