A Retrospective Study on Time Impact of Major Trauma Patients Requiring Access to the Operating Room on the Anesthesia Department of a Pediatric Trauma Center.

Abstract

Background: Trauma is one of the leading causes of death in children. Trauma patients have been demonstrated to require significant resources, including operating room time. We aimed to describe the characteristics and patterns of access to surgery and outcomes of pediatric major trauma patients at The Hospital for Sick Children.

Methods: We retrospectively collected data from the Hospital for Sick Children trauma registry and the hospital's patient electronic record, from June 01, 2018, to October 31 2020. We analyzed a subset of patients requiring surgery in the operating room. The objective was to describe the distribution of major trauma cases requiring operating room access and their hospital length of stay, blood product use, and mortality rates. We summarized the results into three groups based on operating room access timing: patients with immediate access, within 24 h, and after 24 h.

Results: In total, 141 of 721 pediatric major trauma patients (19.6%) underwent surgery and were included. Among these, 67 patients received immediate access to the operating room (47.5%), 37 patients received access within 24 h (26.2%) and 37 patients received access after 24 h (26.2%). The median age was 8 (0-17) years, and 65.2% of patients were male. The median ISS score was 11.5 (1-57). The most frequently involved surgical specialties were orthopedics and neurosurgery. The median hospital length of stay was 6 days (range 1-102). The mortality rate was 1.4%. A multivariable regression analysis showed a correlation between the number of surgical procedures and length of stay (p < 0.01, 95% confidence interval 9.11-11.64).

Conclusion: Major trauma patients have a significant time impact on the anesthesia department. Further studies are needed to better define the pediatric trauma population and its intra-hospital flow and resource use.