The impact of introducing a dedicated day case hand centre on the operative management of distal radial fractures.

Abstract

Introduction: The operative management of distal radial fractures commonly requires inpatient admission, increasing the pressure on acute hospital capacity. Dedicated day case pathways and regional anaesthesia can reduce the length of stay but evidence remains limited.

Methods: A retrospective service assessment was carried out at a large multisite NHS trust. Consecutive adults undergoing operative fixation of isolated distal radial fractures were identified across two control periods (2018-2019 and 2021-2022) and a post-implementation period following the introduction of the North Midlands Hand Centre (NMHC) (2023-2024). The primary outcomes were same-day discharge, length of stay and postoperative complications. Secondary outcomes included anaesthetic technique, hand surgeon involvement and bed-day utilization.

Results: A total of 243 patients were included (Control n = 125; NMHC n = 118), with comparable baseline characteristics. Following NMHC implementation, same-day discharge increased from 66.4% to 98.3% (p < 0.001) and the mean length of stay decreased from 19.4 to 6.6 h (p < 0.001). The mean bed-day utilization per patient fell from 0.69 to 0.06, corresponding to an estimated reduction of approximately 74 inpatient bed-days over 1 year. The use of regional anaesthesia increased from 20.0 to 93.2% (p < 0.001) and hand surgeon involvement increased from 70.4 to 97.5% (p < 0.001). Overall complication rates remained stable (17.6 vs. 13.6%, p = 0.5).

Conclusion: A bespoke day case pathway in a clean-air theatre for distal radial fracture fixation was associated with improved perioperative efficiency without increased complications.

Level of evidence: III.