专用骨科手术室：对患者和医护人员都有益。

Dedicated orthopaedic operating rooms: beneficial to patients and providers alike.

作者信息

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

机构信息

*Division of Orthopaedic Surgery, Department of Surgery, Albany Medical Center, Albany, NY; and †Albany Medical College, Albany, NY.

出版信息

J Orthop Trauma. 2015 Jan;29(1):e18-23. doi: 10.1097/BOT.0000000000000154.

DOI:10.1097/BOT.0000000000000154

PMID:24824099

Abstract

OBJECTIVE

Dedicated orthopaedic operating rooms (DOORs) are increasingly popular solutions to reducing after-hours procedures, physician fatigue, and elective schedule disruptions. Although the benefits to surgeons are well understood, there are comparatively few studies that explore the effects of DOORs on patient care. We compared treatments and outcomes for all consecutive patients with femoral neck fractures, 4 years before and 4 years after implementation of a DOOR-based schedule.

DESIGN

Retrospective case-control study.

SETTING

Level 1 academic trauma center.

PATIENTS

A total of 111 consecutive trauma patients undergoing surgical management of isolated OTA group 31-B femoral neck fractures.

INTERVENTION

Based on individual patient factors and fracture characteristics, patients were managed with either hemiarthroplasty or open reduction internal fixation (ORIF).

MAIN OUTCOME MEASURES

Surgical timing, intervention type, perioperative complications, and postoperative length of stay.

RESULTS

Retrospective analysis revealed a significant decrease in after-hour surgery (4 PM-7:30 AM) for all femoral neck fractures (66.7%-19.3%; P < 0.001). No significant differences were found between the rates of arthroplasty versus those of open reduction internal fixation. Patients undergoing surgical treatment for femoral neck fractures after DOOR suffered significantly fewer morbidities, including significantly decreased rates of postoperative intensive care unit admissions, stroke, infections, and myocardial infarction or congestive heart failure exacerbations. We also observed a significant decrease in postoperative mortality (5.6% pre-DOOR vs. 0% post-DOOR; P = 0.04). Patients undergoing hemiarthroplasty experienced a significant shorter hospitalization (14.5 days pre-DOOR vs. 9.9 days post-DOOR; P = 0.04).

CONCLUSIONS

In our experience, a weekday DOOR is closely associated with improvements in both patient safety and outcomes.

LEVEL OF EVIDENCE

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

摘要

目的

专用骨科手术室（DOORs）作为减少非工作时间手术、医生疲劳和择期手术安排中断的解决方案，越来越受欢迎。尽管对手术医生的益处已广为人知，但探索DOORs对患者护理影响的研究相对较少。我们比较了在基于DOORs的手术安排实施前4年和实施后4年，所有连续股骨颈骨折患者的治疗方法和结果。

设计

回顾性病例对照研究。

地点

一级学术创伤中心。

患者

总共111例连续接受孤立OTA 31-B型股骨颈骨折手术治疗的创伤患者。

干预措施

根据个体患者因素和骨折特征，患者接受半髋关节置换术或切开复位内固定术（ORIF）治疗。

主要观察指标

手术时间、干预类型、围手术期并发症和术后住院时间。

结果

回顾性分析显示，所有股骨颈骨折的非工作时间手术（下午4点至上午7:30）显著减少（从66.7%降至19.3%；P < 0.001）。关节置换术与切开复位内固定术的比例之间未发现显著差异。在采用DOORs后接受股骨颈骨折手术治疗的患者中，发病情况明显减少，包括术后重症监护病房收治率、中风、感染以及心肌梗死或充血性心力衰竭加重的发生率显著降低。我们还观察到术后死亡率显著降低（DOORs实施前为5.6%，DOORs实施后为0%；P = 0.04）。接受半髋关节置换术的患者住院时间显著缩短（DOORs实施前为14.5天，DOORs实施后为9.9天；P = 0.04）。