Dedicated Orthopaedic Operating Rooms

Roberts, Timothy T.; Vanushkina, Maria; Khasnavis, Siddharth; Snyder, James V.; Papaliodis, Dean N.; Rosenbaum, Andrew J.; Uhl, Richard L.; Roberts, Jared; Bagchi, Kaushik

doi:10.1097/bot.0000000000000154

Cited by 25 publications

(12 citation statements)

References 9 publications

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“…Multiple studies over the past 2 decades have reviewed the dedicated orthopaedic trauma room (DOTR) model at tertiary care centers, which has proven itself a helpful solution to the unique urgent but not emergent challenge that orthopaedic trauma presents. [1][2][3][4][5][6][7][8][9][10] A daily DOTR, as described by Min et al, 5 has been shown to reduce patient morbidity and mortality, improve operating room (OR) efficiency, and be economically beneficial. 2 A retrospective study by Roberts et al 4 showed that implementation of a DOTR led to a reduction in after-hours surgery, decreased time to OR, decreased length of stay (LOS), and an overall decrease in morbidity and mortality in patients with femoral neck fractures.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10] A daily DOTR, as described by Min et al, 5 has been shown to reduce patient morbidity and mortality, improve operating room (OR) efficiency, and be economically beneficial. 2 A retrospective study by Roberts et al 4 showed that implementation of a DOTR led to a reduction in after-hours surgery, decreased time to OR, decreased length of stay (LOS), and an overall decrease in morbidity and mortality in patients with femoral neck fractures. Bhattacharyya et al 1 showed that hip fracture surgery performed after hours was associated with increased complication rates and that implementation of a DOTR led to a 72% reduction in the number of hip fracture surgery cases performed after hours.…”

Section: Introductionmentioning

confidence: 99%

“…However, many community-level trauma centers take care of considerable orthopaedic trauma as well; specifically, geriatric hip fractures that are known to benefit from early daytime surgical intervention. 4,5,7,[11][12][13] Community centers may be hesitant to dedicate resources to a full daytime DOTR because it requires enough cases to reap the benefits. 5 As a potential solution, our institution implemented a part-time DOTR from 6 AM to 9 AM Monday through Friday.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effect of a 6 am–9 am Dedicated Orthopaedic Trauma Room on Hip Fracture Outcomes in a Community Level II Trauma Center

McDonald

Ward

Wortham

et al. 2021

Journal of Orthopaedic Trauma

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of a 6 am–9 am Dedicated Orthopaedic Trauma Room on Hip Fracture Outcomes in a Community Level II Trauma Center

McDonald

Ward

Wortham

et al. 2021

Journal of Orthopaedic Trauma

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“…The association between adverse events and surgery performed 'after-hours' been reported in anesthesiology and a number of surgical specialties including orthopedic surgery, general surgery, cardiac surgery [3][4][5][6]. Dedicated daytime emergency orthopedic trauma rooms implemented to reduce after-hours surgery have improved operating suite flow and decreased complications [7,8]. However, the relationship between surgical time of day and postoperative outcomes has been variable in different surgical populations, with other studies demonstrating no relationship [4,9,10].…”

Section: Introductionmentioning

confidence: 99%

‘After-hours’ non-elective spine surgery is associated with increased perioperative adverse events in a quaternary center

et al. 2018

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Purpose 'After-hours' non-elective spinal surgeries are frequently necessary, and often performed under sub-optimal conditions. This study aimed (1) to compare the characteristics of patients undergoing non-elective spine surgery 'After-hours and (2) to compare the perioperative adverse events (AEs) between those undergoing non-elective spine surgery 'after-hours' as compared to 'in-hours'. Methods In this retrospective study of a prospective non-elective spine surgery cohort performed in a quaternary spine center, surgery was defined as 'in-hours' if performed between 0700 and 1600 h from Monday to Friday or 'after-hours' if more than 50% of the operative time occurred between 1601 and 0659 h, or if performed over the weekend. The association of 'after-hours' surgery with AEs, surgical duration, intraoperative estimated blood loss (IOBL), length of stay and in-hospital mortality was analyzed using stepwise multivariate logistic regression. Results A total of 1440 patients who underwent non-elective spinal surgery between 2009 and 2013 were included in this study. A total of 664 (46%) procedures were performed 'after-hours'. Surgical duration and IOBL were similar. About 70% of the patients operated 'after-hours' experienced at least one AE compared to 64% for the 'in-hours' group (p = 0.016). 'After-hours' surgery remained an independent predictor of AEs on multivariate analysis [adjusted OR 1.30, 95% confidence interval (CI) 1.02-1.66, p = 0.034]. In-hospital mortality increased twofold in patients operated 'after-hours' (4.4% vs. 2.1%, p = 0.013). This association lost significance on multivariate analysis (adjusted OR 1.99, 95% CI 0.98-4.06, p = 0.056). Conclusion Non-elective spine surgery performed 'after-hours' is independently associated with increased risk of perioperative adverse events, length of stay and possibly, mortality. Research is needed to determine the specific factors contributing to poorer outcomes with 'after-hours' surgery and strategies to minimize this risk.

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“…The use of dedicated orthopaedic ORs is associated with shorter after-hour surgeries for trauma cases and less disruptions to elective schedules, 8 12 as well as improved patient care, for example, decreased rates of perioperative mortality, postoperative complications and length of stay. 13 The management of non-elective orthopaedic patient flows is however still a challenge as it is often based on ‘ad hoc’ strategies, 14 and limited research is applied to non-elective patient flows. 1 …”

Section: Introductionmentioning

confidence: 99%

Operational strategies to manage non-elective orthopaedic surgical flows: a simulation modelling study

et al. 2017

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ObjectivesTo explore the value of simulation modelling in evaluating the effects of strategies to plan and schedule operating room (OR) resources aimed at reducing time to surgery for non-elective orthopaedic inpatients at a Swedish hospital.MethodsWe applied discrete-event simulation modelling. The model was populated with real world data from a university hospital with a strong focus on reducing waiting time to surgery for patients with hip fracture. The system modelled concerned two patient groups that share the same OR resources: hip-fracture and other non-elective orthopaedic patients in need of surgical treatment. We simulated three scenarios based on the literature and interaction with staff and managers: (1) baseline; (2) reduced turnover time between surgeries by 20 min and (3) one extra OR during the day, Monday to Friday. The outcome variables were waiting time to surgery and the percentage of patients who waited longer than 24 hours for surgery.ResultsThe mean waiting time in hours was significantly reduced from 16.2 hours in scenario 1 (baseline) to 13.3 hours in scenario 2 and 13.6 hours in scenario 3 for hip-fracture surgery and from 26.0 hours in baseline to 18.9 hours in scenario 2 and 18.5 hours in scenario 3 for other non-elective patients. The percentage of patients who were treated within 24 hours significantly increased from 86.4% (baseline) to 96.1% (scenario 2) and 95.1% (scenario 3) for hip-fracture patients and from 60.2% (baseline) to 79.8% (scenario 2) and 79.8% (scenario 3) for patients with other non-elective patients.ConclusionsHealthcare managers who strive to improve the timelines of non-elective orthopaedic surgeries may benefit from using simulation modelling to analyse different strategies to support their decisions. In this specific case, the simulation results showed that the reduction of surgery turnover times could yield the same results as an extra OR.

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Dedicated Orthopaedic Operating Rooms

Abstract: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 25 publications

References 9 publications

Effect of a 6 am–9 am Dedicated Orthopaedic Trauma Room on Hip Fracture Outcomes in a Community Level II Trauma Center

Effect of a 6 am–9 am Dedicated Orthopaedic Trauma Room on Hip Fracture Outcomes in a Community Level II Trauma Center

‘After-hours’ non-elective spine surgery is associated with increased perioperative adverse events in a quaternary center

Operational strategies to manage non-elective orthopaedic surgical flows: a simulation modelling study

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