The value of the dedicated orthopaedic trauma operating room.
BACKGROUND
Trauma centers and orthopaedic surgeons have traditionally been faced with limited operating room (OR) availability for fracture surgery. Orthopaedic trauma cases are often waitlisted and done late at night. We investigated the feasibility of having an unbooked orthopaedic trauma OR to reduce nighttime cases and improve OR flow.


METHODS
A retrospective analysis was performed for two 1 year time periods before and after the introduction of an unbooked trauma OR. The unbooked trauma OR is kept open for urgent and semi-urgent cases from 7:45 am to 5 pm 6 days per week, and is under the control of Orthopaedics; no elective cases are scheduled in the unbooked trauma room. We collected OR time data on two common surgical cases (dynamic hip screw and closed femoral nailing) done before and after introduction of the unbooked orthopaedic trauma OR. We also reviewed data on waitlist cases, surgical time, anesthetic times, OR utilization, and surgical complications before and after the introduction of the unbooked trauma room.


RESULTS
The availability of the unbooked trauma OR significantly improved operating suite flow. The proportion of hip fractures done after 5 pm was reduced by 72% (p<0.01). The number of all orthopaedic waitlist cases started after 5 pm was reduced by 6% (p<0.021). The distinct shift toward performing add-on cases during daytime hours resulted in a 6% reduction in OR over-utilization. Closed femoral nailing done at night required significantly more OR time (261 minutes versus 219 minutes, p<0.04). Hip fracture surgeries and femoral nailings done at night were noted to have a higher incidence of surgical complications (p<0.04 and p<0.036).


CONCLUSIONS
The availability of an unbooked orthopaedic trauma room resulted in a measurable shift from performing "add-on" cases to daytime surgery and may reduce complications. We recommend that hospitals and orthopaedic trauma services commit resources toward having an open OR reserved for orthopaedic trauma.
Bhattacharyya
Timothy
T
Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. tbhattacharyya@partners.org
Vrahas
Mark S
MS
Morrison
Suzanne M
SM
Kim
Edward
E
Wiklund
Richard A
RA
Smith
R Malcolm
RM
Rubash
Harry E
HE
D001071:Appointments and Schedules; D001900:Boston; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005264:Femoral Fractures / Q000601:surgery; D005592:Fracture Fixation / Q000009:adverse effects; D006297:Health Services Accessibility; D006620:Hip Fractures / Q000601:surgery; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control; D009551:Night Care; D009873:Operating Rooms / Q000458:organization & administration* / Q000706:statistics & numerical data; D009985:Orthopedics / Q000458:organization & administration*; D010348:Patient Care Team; D012189:Retrospective Studies; D013997:Time Factors; D014193:Trauma Centers / Q000458:organization & administration*; D014850:Waiting Lists