Editor’s note: The following content was published in the AAOS Now Special Edition and distributed in June 2020. The content was originally scheduled for the AAOS Now Daily Edition, which publishes each year onsite at the AAOS Annual Meeting but this year’s meeting in March was canceled due to COVID-19. Despite the cancellation, members can access virtual content from the Annual Meeting by visiting the Academy’s Annual Meeting Virtual Experience webpage.
The use of a dedicated orthopaedic trauma operating room (OR) improved post-surgical outcomes and reduced costs for pediatric patients with supracondylar humerus fractures, according to a study that Rachel Y. Goldstein, MD, MPH, FAAOS, director of hip preservation at Children’s Hospital Los Angeles, presented as part of the Annual Meeting Virtual Experience.
Patients with orthopaedic injuries requiring surgical treatment who are admitted overnight may be scheduled as add-on surgical cases for the following day, which can disrupt previously scheduled elective surgeries, result in less experienced staff performing add-on cases, or prolong time to surgery for the add-on cases. Prolonged time to surgery can increase costs and hospital burden.
“As a level 1 pediatric trauma center, we have an influx of add-on trauma cases that require prompt attention,” said Joshua Yang, CCRP, clinical research manager at Children’s Hospital Los Angeles. “To mitigate the possibility of disrupting the schedules of elective cases and affecting the patient’s experience, we have adopted the use of a dedicated orthopaedic trauma room in the morning prior to the start of the scheduled OR day to facilitate the surgical management of children with orthopaedic injuries. Observationally, this has shown to be very effective not only for the OR schedules, but for the patients and their outcomes as well. This prompted the study team to investigate patient outcomes and determine whether the use of a dedicated trauma OR is a beneficial practice.”
Researchers conducted a retrospective review of 191 pediatric patients (mean age, 5 years; range, 1–10 years) with supracondylar humerus fractures who were treated at their facility between April 2013 and December 2016. Patients younger than 18 years of age were included if they were treated with closed or open reduction with percutaneous pinning and had follow-up until pin removal. Patients with concomitant injuries, open fracture, or pulseless supracondylar fracture were excluded.
Researchers compared surgical time, complications, hospital length of stay (LOS), and healthcare costs for patients who underwent surgery in the dedicated orthopaedic trauma OR (available for urgent orthopaedic surgical cases Monday through Friday) (n = 42; 22 percent) versus those in a nondedicated OR (n = 149; 78 percent).
No patients in either group required revision surgery. There were no differences in complication rates between the dedicated orthopaedic OR group and the nondedicated group (2.4 percent versus 1.3 percent; P = 0.53) or total surgical time (30.3 minutes versus 22.5 minutes; P = 0.62). Complications, including ulnar nerve palsy, pin tract infection, and osteomyelitis, occurred in three patients.
However, the dedicated orthopaedic OR group had significantly reduced time from presentation to surgery of about four hours and reduced LOS (Table 1). The difference was associated with a mean cost reduction of $939 per patient, according to the researchers. “These benefits demonstrate that use of a dedicated orthopaedic trauma OR can increase the efficiency and improve patient flow in a level 1 pediatric trauma center,” they noted.
“Institutions should consider adopting a dedicated orthopaedic trauma OR to increase the efficiency and decrease the cost of the surgical management of orthopaedic trauma patients,” said Mr. Yang.
“Future investigations may seek to evaluate the outcomes of additional pediatric orthopaedic injuries or disorders to more comprehensively assess the value of a dedicated orthopaedic trauma room,” added Mr. Yang.
The study is limited by its retrospective, single-center design.
Dr. Goldstein’s coauthors of Paper 355, “A Dedicated Orthopaedic Trauma Operating Room Reduced the Time to Surgery, Length of Hospital Stay, and Healthcare Costs of Children with Supracondylar Humerus Fractures,” are Ali Siddiqui, BS; Alexander Nazareth, MD, MS; and Nina R. Lightdale-Miric, MD.
Kerri Fitzgerald is the managing editor of AAOS Now. She can be reached at firstname.lastname@example.org.