Schwab Emi, De Silva Shanika, Livingston Kristin
Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
J Bone Joint Surg Am. 2025 Jun 4;107(11):1180-1187. doi: 10.2106/JBJS.24.01031. Epub 2025 Mar 28.
The operating room start time (ORST) for pediatric femoral fractures is a health-care quality metric used for hospital rankings and accreditation. Factors affecting ORST remain unclear. This study aimed to evaluate the demographic and clinical factors associated with gold-standard (early) ORST (<18 hours) versus delayed ORST (≥18 hours) for pediatric femoral fractures.
A retrospective review was conducted of 216 pediatric patients with a femoral shaft fracture admitted to the emergency department (ED) at a pediatric Level-I trauma hospital from 2021 to 2023. Patient demographic and clinical data were analyzed to identify significant factors associated with ORST. Immediate postoperative outcomes were compared across ORST groups.
In multivariable models, race, ED admission time, comorbidities, and surgery type affected ORST (p < 0.05). Compared with White patients, patients of other racial or ethnic groups, including Hispanic, Black, Asian, and multiracial patients, had 2.4 times higher odds of delayed ORST. Compared with midnight to 6 a.m. ED admissions, the odds of delayed ORST were 6.6 times higher for ED admissions between 6 a.m. and noon and 9.2 times higher for ED admissions between noon and 6 p.m. Patients with comorbidities were 4.7 times more likely to experience delayed surgery compared with healthy patients. Patients who underwent open reduction and internal fixation (ORIF) were 2.5 times as likely as patients who underwent closed reduction (CR) with a spica cast to have delayed ORST. Delayed ORST was associated with longer hospital stay (median, 71 hours) compared with early ORST (median, 41 hours), but not with immediate complications.
ED admission time, race, method of transfer, comorbidities, and procedure type were associated with ORST for pediatric femoral fractures. Longer ORST led to a disproportionately longer hospital stay.
Prognostic Level IV . See Instructions for Authors for a complete description of levels of evidence.
小儿股骨干骨折的手术室开始时间（ORST）是用于医院排名和认证的医疗质量指标。影响ORST的因素尚不清楚。本研究旨在评估与小儿股骨干骨折的金标准（早期）ORST（<18小时）与延迟ORST（≥18小时）相关的人口统计学和临床因素。
对2021年至2023年在一家一级儿科创伤医院急诊科（ED）收治的216例小儿股骨干骨折患者进行回顾性研究。分析患者的人口统计学和临床数据，以确定与ORST相关的显著因素。比较各ORST组的术后即时结果。
在多变量模型中，种族、ED入院时间、合并症和手术类型影响ORST（p<0.05）。与白人患者相比，其他种族或族裔群体的患者，包括西班牙裔、黑人、亚裔和多种族患者，延迟ORST的几率高2.4倍。与午夜至上午6点的ED入院相比，上午6点至中午的ED入院延迟ORST的几率高6.6倍，中午至下午6点的ED入院延迟ORST的几率高9.2倍。与健康患者相比，合并症患者延迟手术的可能性高4.7倍。接受切开复位内固定（ORIF）的患者延迟ORST的可能性是接受闭合复位（CR）加髋人字石膏固定患者的2.5倍。与早期ORST（中位数，41小时）相比，延迟ORST与更长的住院时间（中位数，71小时）相关，但与即时并发症无关。
ED入院时间、种族、转运方式、合并症和手术类型与小儿股骨干骨折的ORST相关。更长的ORST导致住院时间不成比例地延长。
预后IV级。有关证据水平的完整描述，请参阅作者指南。
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