title: Off-Hour Surgery Among Orthopedic Subspecialties at an Urban, Quaternary-Care, Level 1 Trauma Center.
abstract: OBJECTIVE
  We sought to determine and quantify which subspecialties of orthopedic surgeons are operating off hours in an urban, quaternary-care, level 1 trauma center.
  
  
  METHODS
  We used our clinical registry to identify 43,211 orthopedic surgeries performed between January 2008 and December 2011. Our outcome measures were the number and proportion of off-hour surgeries performed as well as the number and proportion of off-hours per subspecialty. The denominators were the total number of surgeries and the total number of surgical hours worked per subspecialty. Subspecialties-based on the primary surgeon who performed the surgery-were arthroplasty, foot and ankle, hand, pediatrics, shoulder, spine, sports, orthopedic trauma, and orthopedic oncology.
  
  
  RESULTS
  A total of 2,431 (5.6%) surgeries were off-hours; the overall ratio of off-hour to on-hour surgeries was 1 to 17. There was a difference in the proportion of off-hour surgeries performed among orthopedic subspecialties: trauma (ratio, 1:5) and pediatric specialists (ratio, 1:5) had the lowest ratio, and shoulder (ratio, 1:152) and sports (ratio, 1:98) specialists the highest. The total number of surgical hours among all specialties was 59,026; of these hours, 3,833 (6.5%) were off-hour. The ratio of off-hour to on-hour surgical hours was 1 to 14. There was a difference in proportion of hours worked off-hour among orthopedic subspecialties; the ratios were greatest for trauma (1:5) and hand (1:5) specialists and the least for shoulder (1:157) and sports (1:92) specialists. Seven percent of hand surgery cases were off-hour, and 16% of the total surgical hours worked by hand surgeons were off-hour.
  
  
  CONCLUSIONS
  In an urban, academic, level 1 trauma and microvascular replantation regional referral hospital, there is a large difference in off-hour surgical volume and duration among orthopedic subspecialties: trauma, pediatric, and hand surgeons performed more off-hour work than their colleagues, with hand and pediatric surgeons the most likely to be working at night.
  
  
  CONCLUSIONS
  These data can inform how we organize, value, and incentivize off-hour care.
authors.affiliation: Hand Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Lans
authors.affiliation: Hand Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA.
authors.forename: Stein J
authors.initials: SJ
authors.lastname: Janssen
authors.affiliation: Hand Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: david.ring@austin.utexas.edu.
authors.forename: David
authors.initials: D
authors.lastname: Ring
mesh_terms: D039602:After-Hours Care / Q000706:statistics & numerical data*; D001900:Boston; D006786:Hospitals, Urban; D006801:Humans; D019637:Orthopedic Procedures / Q000706:statistics & numerical data*; D009985:Orthopedics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014193:Trauma Centers / Q000458:organization & administration
keywords: Trauma; after hour; emergency; fracture; resources