Advantages of a Dedicated Orthopaedic Trauma Room for Children With Fractures of the Femur Treated at a Pediatric Community Hospital.

Abstract

Background: The benefits of a dedicated orthopaedic trauma room (DOTR) for patients with isolated femur fractures have not been reported from a pediatric community hospital.

Methods: Twenty-three years of skeletally immature patients treated for an isolated diaphyseal femur fracture with two flexible intramedullary nails, Pre-DOTR: 2000-2015 and Post-DOTR: 2016-2022, were reviewed for comparison of patient demographics and injury patterns, timing and durations of surgery, fellow presence, duration and cost of hospitalization, and complication rates.

Results: One hundred fifty-three patients were identified. One hundred twenty-six patients underwent surgery pre-DOTR and 27 post-DOTR. Demographics were similar between groups, except the post-DOTR patients were younger (mean age 7.4 years vs 9.0 years, P ​= ​0.002). There was no significant difference in the percentage of patients undergoing surgery within 18 ​h of admission pre- and post-DOTR (78% vs 93%, respectively, P ​= ​0.53). Post-DOTR surgeries were more frequently daytime (93%) than pre-DOTR (56%, P ​< ​0.001). Fellows were present in 8% of pre-DOTR vs 44% of post-DOTR procedures (P ​< ​0.0001). Average durations of surgery post-DOTR were significantly longer (118 ​min vs 93 ​min, P ​= ​0.031). Lengths of stay post-DOTR were significantly shorter (3.0 days vs 3.5 days, P ​= ​0.016), with substantial potential cost savings. There was no significant difference in complication rates pre- and post-DOTR (21% and 22%, P ​= ​0.85).

Conclusions: Implementing a guaranteed first start for orthopaedic trauma via a DOTR at a pediatric community hospital, a pediatric non-Level I or II trauma center, allowed for daytime surgery without prolonging hospital stays for pediatric patients undergoing flexible intramedullary nailing for a femur fracture. Guaranteed morning OR block time for orthopaedic trauma decreased lengths of hospital stay and enabled a larger percentage of surgeries to be done during daytime hours. Shorter hospital stays suggest substantial cost savings, while early daytime surgery for nonemergent procedures avoided burdening families with prolonged waits to surgery.

Key concepts: (1)A daily dedicated orthopaedic trauma room (DOTR) for operative treatment of orthopaedic trauma in a pediatric community hospital results in the vast majority of femur fracture surgeries being performed during daytime hours.(2)Even with a delay of many femur fracture surgeries until the next morning, a DOTR does not increase the fraction of patients treated outside the 18-h window from admission.(3)A DOTR for operative treatment of pediatric femur fractures in a community pediatric hospital can decrease lengths of stay for patients treated for diaphyseal femur fractures.(4)A DOTR may decrease the costs of hospitalization by decreasing lengths of stay for patients treated for diaphyseal femur fractures.

Level of evidence: Therapeutic, Level III - Retrospective comparison study.