Section of Orthopaedics, Cumming School of Medicine, University of Calgary, 2500 University Drive, NW T2N 1N4, Calgary, AB, Canada.
Arthritis Research Canada, 5591 Number 3 Rd, V6 × 2C7, Richmond, BC, Canada.
Injury. 2022 Jun;53(6):1999-2004. doi: 10.1016/j.injury.2022.03.010. Epub 2022 Mar 8.
Orthopaedic trauma does not present in a linear fashion. Fluctuations in trauma volumes, after-hours surgery and surgical wait times impact orthopaedic surgeons and patients. There is little research focussing on how surgical trauma volumes change throughout the week. This study investigated the relationship between day of the week and surgical orthopaedic trauma volumes, after-hours surgery, and wait times for orthopaedic trauma patients.
All unscheduled surgical orthopaedic trauma cases presenting to one level I and three level IV urban adult trauma centers between 2008 and 2018 were retrospectively reviewed. Fluctuations in orthopaedic trauma volumes and amount of after-hours surgeries completed were investigated using Multivariable Poisson regression. Fluctuations in patient wait times were investigated using linear regression.
Weekends were associated with increased surgical wait times (8.9%, p<0.001) despite decreased surgical trauma volumes (9.1%, p<0.001). Surgical orthopaedic trauma volumes were elevated on weekdays and decreased on weekends. More after-hours surgeries were performed from Thursday to Saturday with most performed on Friday night (26.6%, p<0.001). Surgical wait times increased midweek and remained high until Saturday.
With a lack of dedicated trauma resources on the weekend, a significant increase in after-hours surgery and surgical wait times was identified following surgical volumes peaking on Thursday and Friday. We suggest adapting resource allocation to reflect surgical volumes. Dedicated weekend orthopaedic trauma resources or an adaptable schedule during increased orthopaedic trauma have the potential to ease this bottleneck, improve patient care, and decrease hospital costs.
骨科创伤的发生并非呈线性趋势。创伤量的波动、非工作时间手术和手术等待时间会对骨科医生和患者产生影响。目前，针对整个星期内手术创伤量如何变化的研究甚少。本研究调查了星期与手术骨科创伤量、非工作时间手术以及骨科创伤患者等待时间之间的关系。
回顾性分析了 2008 年至 2018 年期间在一家一级和三家四级城市成人创伤中心接受非计划性手术的所有骨科创伤患者。使用多变量泊松回归调查骨科创伤量和完成的非工作时间手术量的波动情况。使用线性回归调查患者等待时间的波动情况。
尽管手术创伤量减少了 9.1%（p<0.001），但周末的手术等待时间仍延长了 8.9%（p<0.001）。平日手术骨科创伤量增加，周末减少。周四至周六进行了更多的非工作时间手术，其中周五晚上进行的手术最多（26.6%，p<0.001）。手术等待时间在周中增加，直到周六仍居高不下。
由于周末缺乏专门的创伤资源，在周四和周五手术量达到峰值后，发现非工作时间手术和手术等待时间显著增加。我们建议调整资源分配以反映手术量。在骨科创伤量增加时，配备专门的周末骨科创伤资源或灵活的时间表，有可能缓解这一瓶颈，改善患者护理并降低医院成本。
