Dedicated Trauma Operating Rooms in Hand Surgery: A North American Survey of Access, Impact, and Opportunities for System-Level Improvement.

Abstract

Background: Dedicated trauma operating rooms (DTORs) have improved surgical efficiency and outcomes in general and orthopedic surgery, yet their adoption and impact in hand surgery remain unclear. This study aimed to assess access to DTORs among hand surgeons and evaluate their observed impacts among those with access and perceived impacts among those without access on operating room efficiency, patient outcomes, surgeon wellness, and resident education.

Methods: American Association for Hand Surgery members (N = 1453) and Canadian Society for Surgery of the Hand members (N = 415) were surveyed. The survey covered practice characteristics, DTOR availability, and perceived or actual impact on operating room efficiency, patient outcomes, surgeon wellness, and resident education. Quantitative responses were analyzed descriptively, and open-text responses underwent qualitative synthesis.

Results: Of the 90 respondents, most practiced in the United States (79%) and had an academic practice (70%). Only 12% reported access to a DTOR for hand surgery, N = 4/70 in the United States, N = 6/16 in Canada, and N = 1/3 in another country. Among those with access, all reported a positive impact on clinical practice, and most perceived improvements in scheduling conflicts, after-hours cases, and patient outcomes. Similar results were found among those without access (88%). Free-text responses emphasized the need for adequate staffing, centralized scheduling, flexible models, and regional anesthesia support to optimize DTOR utilization.

Conclusions: Access to DTORs in hand surgery is limited, yet both observed and perceived impacts suggest important benefits for clinical efficiency, patient outcomes, and provider wellness.