A dedicated orthopaedic trauma room (DOTR) increased surgical efficiency and resulted in marked cost benefits for centers, according to findings from a Canadian study. The findings were presented by Johnathan Lex, MB ChB, orthopaedic surgery resident at the University of Toronto, at the AAOS 2022 Annual Meeting.
According to the researchers, previous work has established the clinical and organizational benefits of DOTRs in the management of trauma patients, given that after-hours care is associated with surgeon fatigue, increased staffing-related costs, and risks to patients.
“Our study also specifically addresses the hesitation [to implement DOTRs due to] potential loss of profit from elective surgeries,” wrote Dr. Lex and colleagues.
To further establish the value and impact of DOTR implementation on OR efficiency and costs, Dr. Lex and colleagues performed a retrospective cost-analysis study of a single academic-affiliated community hospital in Toronto, Canada, that implemented a DOTR. Over a four-year period (2016–2019), patients in the study underwent common orthopaedic trauma procedures, including hip hemiarthroplasty as well as ORIF (open reduction–internal fixation) of the ankle, femur, elbow, and distal radius.
The investigators collected patient data for the two years before and the two years after the implementation of a DOTR. After adjusting for the number of cases performed, the investigators compared the available patient data between the two time periods to determine efficiency of the DOTR approach. The duration of surgery and number of daytime and after-hours cases were evaluated pre- and post-implementation.
Researchers calculated the cost savings of performing trauma cases during the day, as well as the opportunity cost (i.e., loss of potential profits) of displacing elective cases by performing them during the day. Additionally, the investigators performed a sensitivity analysis that accounted for various overtime costs and hospital elective case profits.
In total, the researchers examined 1,960 orthopaedic surgery cases performed before and after DOTR implementation. The researchers noted that all procedures performed after establishment of the DOTR had reduced total operative time (Table 1). After the researchers accounted for the total number of each surgical procedure performed, the mean weighted reduction in operative time was 31.4 percent, and the mean time saved was 29.6 minutes per intervention.
By procedure, the pre- and post-DOTR mean surgical durations, respectively, were:
- ankle ORIF: 111 minutes and 75 minutes (P = 0.010)
- hip hemiarthroplasty: 72 minutes and 60 minutes (P = 0.008)
- femur fracture fixation with dynamic hip screws: 65 minutes and 44 minutes (P = 0.035)
- femur fracture fixation with cephalomedullary nails: 93 minutes and 66 minutes (P = 0.037)
- distal radius ORIF: 112 minutes and 44 minutes (P = 0.001)
- elbow ORIF: 89 minutes and 58 minutes (P = 0.090)
There was no significant change in mean surgical duration after DOTR implementation for elbow ORIF. Additionally, the number of surgical hours during the day increased by 21 percent, while the number of surgical hours during the evening decreased by 37.8 percent. Also, staffing costs for overtime work decreased by $24,976, while opportunity costs increased by $22,500, resulting in a net profit of $2,476.
According to the study’s results, the cost savings partially stemmed from reduced times in the OR as well as decreased nurse overtime. “Widespread implementation can improve patient care while still remaining financially favorable,” they wrote.
Dr. Lex’s coauthors of “A Dedicated Orthopaedic Trauma Room Improves Efficiency while Remaining Financially Net Positive” are Aazad Abbas, BSc; Colby Oitment, MD; Paul Kim Chiu Wong, MD; Jihad Abouali, MD; Albert Yee, MD; Hans J. Kreder, MD, MPH, FAAOS, FRCSC; Jeremie Larouche, MD, MSc; and Jay Toor, MD, MBA.
Brandon May is a freelance writer for AAOS Now.