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Effect of a 6 am-9 am Dedicated Orthopaedic Trauma Room on Hip Fracture Outcomes in a Community Level II Trauma
Michael McDonald1, Lawrence Ward1, Heather Wortham1
1Department of Orthopaedic Surgery Henry Ford Macomb Hospital, Clinton Township, MI.
Objective:
To assess the outcomes of elderly hip fracture surgeries performed 12 months before and 12 months after the implementation of a daily 6 am-9 am dedicated orthopaedic trauma room (DOTR) at a Level II community trauma center.
Design:
Retrospective cohort study.
Setting:
Level II academic trauma center.
Patients:
A total of 431 consecutive trauma patients undergoing surgical management of isolated low-energy hip fractures from January 1, 2018, to December 31, 2019.
Intervention:
Implementation of a 6 am-9 am DOTR Monday through Friday.
Main Outcome Measures:
Time to surgery, number of cases performed after hours, surgical time, 90-day morbidity and mortality, and time to therapy.
Results:
Retrospective analysis showed that despite a 24% increase in surgical hip fracture volume, implementation of a part-time DOTR led to a decrease in after-hours surgery (32.4% vs. 19.6%; P = 0.008) and patients requiring the intensive care unit postoperatively (7% vs. 3.8%; P = 0.036). Surgeries performed after hours were longer than that of surgeries performed during the daytime (82.0 vs. 68 minutes; P = 0.003) and had more complications (pneumonia, pulmonary embolism, and surgical site infection; P = 0.002, 0.047, 0.024, respectively).
Conclusions:
Our results show that a part-time DOTR in a community Level II hospital is associated with improvement in patient care.
Level Of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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