Bhattacharyya Timothy, Vrahas Mark S, Morrison Suzanne M, Kim Edward, Wiklund Richard A, Smith R Malcolm, Rubash Harry E
Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
J Trauma. 2006 Jun;60(6):1336-40; discussion 1340-1. doi: 10.1097/01.ta.0000220428.91423.78.
Trauma centers and orthopaedic surgeons have traditionally been faced with limited operating room (OR) availability for fracture surgery. Orthopaedic trauma cases are often waitlisted and done late at night. We investigated the feasibility of having an unbooked orthopaedic trauma OR to reduce nighttime cases and improve OR flow.
A retrospective analysis was performed for two 1 year time periods before and after the introduction of an unbooked trauma OR. The unbooked trauma OR is kept open for urgent and semi-urgent cases from 7:45 am to 5 pm 6 days per week, and is under the control of Orthopaedics; no elective cases are scheduled in the unbooked trauma room. We collected OR time data on two common surgical cases (dynamic hip screw and closed femoral nailing) done before and after introduction of the unbooked orthopaedic trauma OR. We also reviewed data on waitlist cases, surgical time, anesthetic times, OR utilization, and surgical complications before and after the introduction of the unbooked trauma room.
The availability of the unbooked trauma OR significantly improved operating suite flow. The proportion of hip fractures done after 5 pm was reduced by 72% (p<0.01). The number of all orthopaedic waitlist cases started after 5 pm was reduced by 6% (p<0.021). The distinct shift toward performing add-on cases during daytime hours resulted in a 6% reduction in OR over-utilization. Closed femoral nailing done at night required significantly more OR time (261 minutes versus 219 minutes, p<0.04). Hip fracture surgeries and femoral nailings done at night were noted to have a higher incidence of surgical complications (p<0.04 and p<0.036).
The availability of an unbooked orthopaedic trauma room resulted in a measurable shift from performing "add-on" cases to daytime surgery and may reduce complications. We recommend that hospitals and orthopaedic trauma services commit resources toward having an open OR reserved for orthopaedic trauma.
创伤中心和骨科医生传统上面临骨折手术可用手术室（OR）有限的问题。骨科创伤病例经常被列入等候名单并在深夜进行手术。我们研究了设立一个未预订的骨科创伤手术室以减少夜间手术病例并改善手术室流程的可行性。
对引入未预订创伤手术室前后的两个1年时间段进行回顾性分析。未预订的创伤手术室每周6天从上午7:45至下午5点开放用于紧急和半紧急病例，由骨科控制；未预订的创伤手术室不安排择期病例。我们收集了引入未预订的骨科创伤手术室前后两种常见手术病例（动力髋螺钉和闭合股骨钉内固定术）的手术室时间数据。我们还回顾了引入未预订创伤手术室前后等候名单病例、手术时间、麻醉时间、手术室利用率和手术并发症的数据。
未预订创伤手术室的可用性显著改善了手术室流程。下午5点后进行的髋部骨折手术比例降低了72%（p<0.01）。下午5点后开始的所有骨科等候名单病例数量减少了6%（p<0.021）。日间进行附加病例的明显转变导致手术室过度使用减少了6%。夜间进行闭合股骨钉内固定术需要显著更多的手术室时间（261分钟对219分钟，p<0.04）。夜间进行的髋部骨折手术和股骨钉内固定术的手术并发症发生率更高（p<0.04和p<0.036）。
设立未预订的骨科创伤手术室导致了从进行“附加”病例到日间手术的可衡量转变，并可能减少并发症。我们建议医院和骨科创伤服务部门投入资源设立一个为骨科创伤预留的开放手术室。
