title: The long-term outcome after treatment for patients with tibial fracture treated with intramedullary nailing is not influenced by time of day of surgery and surgeon experience.
abstract: BACKGROUND
  The objective of the present study was to evaluate the relationship between clinical outcome and time of day of surgery and experience level of the surgeon. Secondly, we examined the relationship between the length of hospital stay and the time of day of surgery.
  
  
  METHODS
  This retrospective cross-sectional cohort design study included patients treated with intramedullary nailing at Aalborg University Hospital from 1998 to 2008 after tibial shaft fractures (N = 294). At follow-up, the participants completed the Knee Injury and Osteoarthritis Outcome Score (KOOS). Age, sex, complications, length of hospital stay, start time of surgery, and education level of surgeons were recorded.
  
  
  RESULTS
  The long-term analysis of the KOOS assessment shows no significant association between time of day of surgery and the level of surgeon experience. There was no difference in complication rates between time of day of surgery and the level of surgeon experience. The secondary outcome analysis showed an estimated increased risk of 25 % (p = 0.001), for a longer length of hospital stay when operated by a trainee at night-hours compared to day-hours, and an estimated increased risk of 17 % (p = 0.002) for longer length of stay, when operated at day-hours by a trauma surgeon compared to a trainee.
  
  
  CONCLUSIONS
  Complication rates and KOOS outcome after surgery with intramedullary nailing were not influenced by time of day of surgery and experience level of the surgeon. The lengths of hospital stay increase significantly when surgery is performed at night by trainee surgeons, but not when performed by trauma surgeons.
authors.affiliation: Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg University, 18-20 Hobrovej, 9000, Aalborg, Denmark. peter.larsen@rn.dk.
authors.forename: P
authors.initials: P
authors.lastname: Larsen
authors.affiliation: Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: L
authors.initials: L
authors.lastname: Koelner-Augustson
authors.affiliation: Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: R
authors.initials: R
authors.lastname: Elsoe
authors.affiliation: Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Petruskevicius
authors.affiliation: Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: S
authors.initials: S
authors.lastname: Rasmussen
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005594:Fracture Fixation, Intramedullary; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology* / Q000601:surgery; D012189:Retrospective Studies; D066231:Surgeons / Q000592:standards; D013978:Tibial Fractures / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D014193:Trauma Centers / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: Outcome; Surgeon experience; Time of surgery