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Updated: Jun 27, 2025
Pseudofracture: An Acute Peripheral Tissue Trauma Model
Published on: April 18, 2011
Characterizing trauma patients with delays in orthopedic process measures
Nishant Gohel1, Pranav Khambete, Laura Gerhardinger
1From the Department of Orthopaedic Surgery (N.G.), Penn State University, Hershey, Pennsylvania; Department of Orthopaedic Surgery (P.K., R.V.), Wayne State University, Detroit; Department of Surgery (L.J.G., M.R.H.) and Center for Healthcare Outcomes and Policy (L.J.G., M.R.H., B.W.O.), University of Michigan, Ann Arbor, Michigan; Department of Orthopaedic Surgery (A.N.M.), Washington University in St. Louis, Missouri; Department of Orthopaedic Surgery (P.R.W.), Dartmouth Health, Lebanon, New Hampshire; Center for Surgery and Public Health (M.P.J.), Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery (J.W.S.), University of Washington, Seattle, Washington; and Department of Orthopaedic Surgery (B.W.O.), University of Michigan, Ann Arbor, Michigan.
Surgical delays in orthopaedic trauma care are common, especially in "healthy" patients, and linked to worse outcomes. Accounting for patient factors is crucial for accurate quality improvement in trauma care.
Area of Science:
- Orthopaedic surgery
- Trauma care
- Quality improvement
Background:
- Early surgical intervention in orthopaedic injuries reduces morbidity and mortality.
- Current trauma quality improvement programs use process measures like femoral shaft fixation within 24 hours.
- Existing measures do not account for patients unable to undergo timely surgery due to instability.
Purpose of the Study:
- To characterize factors associated with delays in orthopaedic trauma process measures.
- To assess the impact of surgical delays on inpatient outcomes.
- To analyze the rate of delay in physiologically stable ("healthy") patients.
Main Methods:
- Retrospective cohort study of 5,199 femoral shaft fractures and 1,291 open tibial shaft fractures (2017-2022).
- Data from 35 ACS-COT verified Level 1 and Level 2 trauma centers.
- Multivariable logistic regression identified factors associated with delays >24 hours.
Main Results:
- 31.8% of femoral shaft fracture fixations and 11.2% (femur) / 18.7% (tibia) of tibial shaft fracture fixations were delayed.
- 47.1% of delayed femur cases were in "healthy" patients.
- High Injury Severity Score (ISS), older age, and comorbidities predicted delays and were associated with increased complications.
Conclusions:
- Substantial delays occur in orthopaedic trauma process measures, influenced by patient characteristics.
- These delays are linked to a higher incidence of complications.
- Accurate quality improvement requires understanding and accounting for factors causing surgical delays.
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