OTA 2004 Posters

The Value of the Dedicated Orthopaedic Trauma Operating Room

Timothy Bhattacharyya, MD (b-Stryker); Suzanne M. Morrison, MPH (n); Richard Wiklund MD (n); Kevin S. King, BS (n); R. Malcolm Smith, MD (n);

Harry Rubash, MD (n); Mark Vrahas, MD (a-Synthes Research Grant);

Partners Orthopaedic Trauma Service, Massachusetts General Hospital,

Boston, Massachusetts, USA

Purpose: We documented the utility of an unbooked orthopaedic trauma operating room (OR) to improve patient care.

Methods: A retrospective analysis was performed for two 1-year time periods before and after the introduction of an unbooked trauma OR. In 1999, one OR was designated as trauma room 6 days per week. The unbooked OR is available for urgent and semi-urgent cases from 7:45 AM to 5 PM and is under the control of Orthopaedics. We compared OR time data for two common surgical cases (dynamic hip screw and closed femoral nailing) performed before and after introduction of the unbooked room. We also reviewed data on OR utilization and wait-list cases before and after the introduction of the unbooked room.

Results: The availability of the unbooked trauma OR reduced the proportion of hip-fracture repairs performed after 5 PM by 72%. The number of all orthopaedic wait-list repairs started after 5 PM was reduced by 6%. Closed femoral nailing performed at night required significantly more OR time (261 minutes vs. 219 min, P <0.04). Trauma cases treated at night required an average of 41 minutes longer to complete. Three of three surgical complications were noted to have occurred in hip-fracture cases treated at night (P <0.01). Operating-room flow was improved by a distinct shift toward treatment of wait-list cases during daytime hours. The 6% shift of surgical hours to daytime resulted in an estimated cost saving of $285,000.

Conclusion: The availability of an unbooked orthopaedic trauma room resulted in a measurable shift from performing "add-on" cases to daytime surgery. Shifting surgery to daytime improves patient care by reducing OR times and improving OR flow and may reduce the number of surgical complications. We recommend that hospitals and orthopaedic trauma services commit resources toward having an open OR reserved for orthopaedic trauma.