A Dedicated Trauma Operating Room for Hand Surgery Reduces After-Hours Cases and Costs without Affecting Wait Times:...

Area of Science:

• Orthopaedic Surgery
• Trauma Care
• Health Services Research

Background:

• After-hours hand trauma care presents challenges including surgeon fatigue, increased complications, and higher costs.
• Dedicated trauma operating rooms (DTORs) aim to improve access and outcomes in orthopaedic and trauma surgery.
• This study evaluated the impact of a DTOR for hand surgery on after-hours cases and surgical wait times.

Purpose of the Study:

• To measure the effect of a dedicated trauma operating room (DTOR) on the proportion of after-hours hand surgeries.
• To assess the impact of DTOR implementation on consultation-to-surgery wait times.
• To analyze changes in hospital costs, caseload, complications, and revision rates following DTOR implementation.

Main Methods:

• Retrospective cohort study comparing adult hand trauma patients before (Aug 2018–Jan 2020) and after (Aug 2022–Jan 2024) DTOR implementation.
• Primary outcomes: proportion of after-hours emergency cases and wait times from consultation to surgery.
• Secondary outcomes: total hospital costs, caseload, surgical complications, and revision surgeries analyzed using regression models and univariate analysis.

Main Results:

• After-hours emergency hand surgeries decreased from 18% to 8% post-DTOR implementation (OR 0.47, p=0.03).
• Median wait times remained similar (6 days pre-DTOR vs. 8 days post-DTOR; p=0.64).
• DTOR implementation was associated with a 19% reduction in total hospital costs (p<0.001) and fewer complications (5% to 2%; p=0.03).

Conclusions:

• Dedicated trauma operating rooms (DTORs) effectively reduce after-hours hand surgeries and complication rates.
• DTOR implementation leads to significant hospital cost savings without adversely affecting wait times or revision rates.
• Integrating DTORs is a viable strategy to enhance operational efficiency and patient outcomes in hand trauma care.