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LaRosa SK, Stone XA, Fenninger AA, Harshaw NS, Hoffman KM, Moore KG, Perea LL. Effects of Time of Arrival on Trauma Patient Outcomes. Am Surg 2024; 90:2188-2193. [PMID: 38647268 DOI: 10.1177/00031348241248694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Arriving during "off hours" to the hospital can put patients at greater risk of complications or mortality given lesser staff. Our goal was to investigate this in trauma patients with an Injury Severity Score (ISS) of >15. We hypothesized that the patients admitted late at night and/or during the weekend, would have worse outcomes, delays to the operating room (OR), and longer lengths of stay (LOS) compared to those who arrive on a weekday during the day. METHODS We performed a retrospective study from 8/1/2019 to 8/1/2022 of all trauma patients with an ISS >15 at our Level 1 Trauma Center. Patients <18 years, dead on arrival, or transferred out were excluded. Univariate and multivariable analysis were performed comparing weekday vs weekend arrivals, day vs night shift arrivals, and with patients grouped as weekday day, weekday night, weekend day, and weekend night. The primary outcome was mortality. RESULTS 953 patients met inclusion criteria. The patients that arrived on the weekend and at night were significantly younger than their counterparts. A significantly greater percentage of Black patients arrived during night shift. Mortality, hospital LOS, and ICU LOS did not differ based on day or time of arrival. CONCLUSION Contrary to our hypothesis, our study did not find a significant difference in outcomes when evaluating based on a patient's time of arrival. This gives credence that our mature trauma center can provide the same level of care despite the time of a severely injured patient's time of arrival.
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Affiliation(s)
- Samantha K LaRosa
- Department of Surgery, Division of Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Xander A Stone
- Department of Surgery, Division of Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Ashley A Fenninger
- Department of Surgery, Division of Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Nathaniel S Harshaw
- Department of Surgery, Division of Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Kathryn M Hoffman
- Department of Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Katherine G Moore
- Department of Surgery, Division of Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Lindsey L Perea
- Department of Surgery, Division of Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, Lancaster, PA, USA
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Florissi I, Radomski SN, Shou B, Cloyd JM, Kim A, Grotz T, Fournier K, Baumgartner JM, Lambert L, Abbott DE, Schwartz P, Staley CA, Clarke C, Dineen S, Patel SH, Wilson GC, Raoof M, Johnston FM, Greer JB. Weekend Discharge Is Not Associated With Increased Readmission After Hyperthermic Intraperitoneal Chemotherapy. J Surg Res 2024; 293:403-412. [PMID: 37806228 DOI: 10.1016/j.jss.2023.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/18/2023] [Accepted: 08/26/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION We explored the association between weekend discharge and 30- and 90-d readmission rates in patients undergoing hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for peritoneal carcinomatosis. METHODS The US HIPEC Collaborative database, comprised of a longitudinal cohort of patients undergoing CRS/HIPEC for peritoneal carcinomatosis at twelve academic institutions between 2000 and 2017, was queried for date of discharge information. Patients were retrospectively divided into weekday and weekend/holiday discharge groups. Patients <18 y old, lacking day of discharge information, or who experienced intraoperative/in-hospital mortality were excluded. Comparisons were made between patients discharged on a weekday versus those discharged on a weekend or major holiday. RESULTS 1415 patients met inclusion criteria for the study: 1108 (78%) patients with a weekday discharge and 308 (22%) with a weekend/holiday discharge. Median age at time of surgery was 55 y (Interquartile Range: 46-63); 59% (n = 841) patients were female, 25% (n = 328) of patients had high volume disease (defined as a peritoneal cancer index >20 intraoperatively), and 92% (n = 1210) of patients had a complete cytoreduction (defined as a completeness of cytoreduction score of 0 or 1). Overall, 15% (n = 218) of patients were readmitted within 30 d and 19% (n = 265) within 90 d. In a linear mixed effects model, weekend discharge was not associated with higher 30- or 90-d readmissions (P = 0.291, P = 0.743). CONCLUSIONS Weekend discharges are safe following CRS/HIPEC. Length of stay initiatives should focus on discharging the patient when medically ready, rather than avoiding weekend discharge out of an abundance of caution.
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Affiliation(s)
- Isabella Florissi
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shannon N Radomski
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Benjamin Shou
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jordan M Cloyd
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Alex Kim
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Travis Grotz
- Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, Minnesota
| | - Keith Fournier
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joel M Baumgartner
- Division of Surgical Oncology, Department of Surgery, University of California, San Diego, La Jolla, California
| | - Laura Lambert
- Peritoneal Surface Malignancy Program, Section of Surgical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Daniel E Abbott
- Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Patrick Schwartz
- Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Charles A Staley
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Callisia Clarke
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sean Dineen
- Moffitt Cancer Center, Department of Gastrointestinal Oncology, Department of Oncologic Sciences, Morsani College of Medicine, Tampa, Florida
| | - Sameer H Patel
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Gregory C Wilson
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Mustafa Raoof
- City of Hope National Medical Center, Department of Surgery, Duarte, California
| | - Fabian M Johnston
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan B Greer
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Nardelli P, Giesinger J, Liebensteiner M, Pagenstert G, Neururer S, Leitner H, Dammerer D, van Rooij F, Saffarini M. Moonlight surgery: no influence of moon phase or Friday 13th on outcomes of total knee arthroplasty. Arch Orthop Trauma Surg 2023; 143:6169-6175. [PMID: 37306775 DOI: 10.1007/s00402-023-04919-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 05/21/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The purpose of the present study was to investigate associations between revision-free survival and functional scores of total knee arthroplasty (TKA) and moon phase on the day of surgery, as well as operations performed on a Friday 13th. PARTICIPANTS The data of all patients that received TKA between 2003 and 2019 were extracted from the Tyrol arthroplasty registry. Patients that had undergone previous total or partial knee arthroplasty as well as patients that had missing pre- or post-operative WOMAC were excluded. Patients were allocated to one of the following four groups according to moon phase on the day of surgery: new, waxing, full and waning. Patients operated on a Friday 13th were also identified and compared to patients operated on any other days/dates. A total of 5923 patients met the inclusion criteria, with mean age of 69 ± 9 years, and comprising 62% women. RESULTS There were no significant differences in revision-free survival among the four moon phase groups (p = 0.479), and no significant differences in preoperative and postoperative total WOMAC (p = 0.260, p = 0.122), There were no significant differences in revision-free survival patients operated on Friday 13th vs. other days/dates (p = 0.440). The preoperative total WOMAC was significantly worse for patients operated on a Friday 13th (p = 0.013), which was observed in the pain (p = 0.032) and function (p = 0.010) subscales. There were no significant differences in postoperative total WOMAC at 1 year follow-up (p = 0.122). CONCLUSIONS Neither moon phase on the day of surgery nor Friday 13th were associated with revision-free survival or clinical scores of TKA. Patients operated on a Friday 13th had significantly worse preoperative total WOMAC but similar postoperative total WOMAC at 1-year follow-up. These findings could help reassure patients that TKA renders consistent outcomes regardless of the preoperative pain or function, and in spite of bad omens or moon phases.
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Affiliation(s)
- Paul Nardelli
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes Giesinger
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Geert Pagenstert
- Clarahof Clinic of Orthopaedic Surgery, Merian-Iselin-Hospital Swiss Olympic Medical Center, Basel, Switzerland
| | - Sabrina Neururer
- Institute for Clinical Epidemiology, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Hermann Leitner
- Institute for Clinical Epidemiology, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Dietmar Dammerer
- Department of Orthopaedics and Traumatology, University Hospital Krems, Krems, Austria
| | - Floris van Rooij
- ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland
- Clinique Trenel, Sainte Colombe, France
| | - Mo Saffarini
- ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland.
- Clinique Trenel, Sainte Colombe, France.
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Ko J, Kong V, Amey J, Yen DA, Clarke D, Christey G. The "weekend effect" does not impact on outcome of trauma laparotomy - Experience from a level 1 trauma centre in New Zealand. Chin J Traumatol 2023; 26:73-76. [PMID: 36396508 PMCID: PMC10071321 DOI: 10.1016/j.cjtee.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 09/20/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Trauma centres have been proven to provide better outcomes in developed countries for overall trauma, but there is limited literature on the systematic factors that describe any discrepancies in outcomes for trauma laparotomies in these centres. This study was conducted to examine and interrogate the effect of systematic factors on patients undergoing a trauma laparotomy in a developed country, intending to identify potential discrepancies in the outcome. METHODS This was a retrospective study of all laparotomies performed for trauma at a level 1 trauma centre in New Zealand. All adult patients who had undergone an index laparotomy for trauma between February 2012 and November 2020 were identified and laparotomies for both blunt and penetrating trauma were included. Repeat laparotomies and trauma laparotomies in children were excluded. The primary clinical outcomes reviewed included morbidity, length of hospital stay, and mortality. All statistical analysis was performed using R v.4.0.3. RESULTS During the 9-year study period, 204 trauma laparotomies were performed at Waikato hospital. The majority (83.3%) were performed during office hours (170/204), and the remaining 16.7% were performed after hours (34/204). And 61.3% were performed on a weekday (125/204), whilst 38.7% were performed on the weekend/public holiday (79/204). Most of the parameters in office hours and after hours groups had no statistically significant difference, except lactate (p = 0.026). Most of the variables in weekday and weekend groups had no statistically significant difference, except pH, lactate, length of stay, and gastrointestinal complications (p = 0.012, p < 0.001, p = 0.003, p = 0.020, respectively). CONCLUSION The current trauma system at Waikato hospital is capable of delivering care for trauma laparotomy patients with the same outcome regardless of working hours or after hours, weekday or weekend. This confirms the importance of a robust trauma system capable of responding to the sudden demands placed on it.
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Affiliation(s)
- Jonathan Ko
- Department of Surgery, University of Auckland, Auckland, New Zealand.
| | - Victor Kong
- Department of Trauma, Waikato Hospital, Hamilton, New Zealand; Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Janet Amey
- Te Manawa Taki Trauma System, Waikato, New Zealand
| | - Damien Ah Yen
- Department of Trauma, Waikato Hospital, Hamilton, New Zealand; Te Manawa Taki Trauma System, Waikato, New Zealand
| | - Damian Clarke
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Grant Christey
- Department of Surgery, University of Auckland, Auckland, New Zealand; Department of Trauma, Waikato Hospital, Hamilton, New Zealand; Te Manawa Taki Trauma System, Waikato, New Zealand
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Cohen DA, Thomas Perez LS, Chemas-Velez MM, Tseng CC, Eloy JA, Fang CH. Analysis of Care and Outcomes for Epistaxis Weekend Admissions. Otolaryngol Head Neck Surg 2023; 168:1401-1410. [PMID: 36939540 DOI: 10.1002/ohn.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/23/2022] [Accepted: 12/07/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To study differences in care of patients admitted for epistaxis during the weekend compared to the weekday. STUDY DESIGN Retrospective database review. SETTING 2003 to 2014 National Inpatient Sample. METHODS Patients admitted for a primary diagnosis of epistaxis were extracted from the National Inpatient Sample from 2003 to 2014. Univariate and multivariate analyses were applied to assess differences in patient demographics, clinical characteristics, treatment, and outcomes between weekend and weekday admissions. RESULTS A total of 39,329 cases were included in our study cohort, with 28,458 weekday admissions and 10,892 weekend admissions. There was no significant difference in patient race, gender, insurance status, hospital ownership status, or location between weekend and weekday admissions (p > .05). Most weekend admissions were emergent (82.2%) and were treated with packing (51.8%). Upon performing logistic regression, the likelihood of emergent admission (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.32-1.51, p < .001) and prolonged length of stay (OR 1.11, 95% CI 1.05-1.17, p < .001) was higher for weekend admissions versus weekday admissions. Moreover, odds of packing for epistaxis were significantly higher (OR 1.14, 95% CI 1.09-1.19, p < .001) on the weekend, while odds of ligation (OR 0.88, 95% CI 0.80-0.97, p = .013) and endovascular arterial embolization (OR 0.74, 95% CI 0.65-0.84, p < .001) were lower. There were no significant differences in in-hospital mortality, patient discharge disposition, and total hospital charges (p > .05). CONCLUSION Patients primarily admitted for epistaxis over the weekend were more likely to be emergent, experienced prolonged length of stay, and be treated nonoperatively with packing, than weekday admissions. No significant differences in patient insurance or hospital ownership were identified. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- David Avery Cohen
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | | | - Maria Manuela Chemas-Velez
- Department of Otolaryngology and Maxillofacial Surgery, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Christopher C Tseng
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Center for Skull Base and Pituitary Surgery, Rutgers New Jersey Medical School, Neurological Institute of New Jersey, Newark, New Jersey, USA.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Otolaryngology and Facial Plastic Surgery, Saint Barnabas Medical Center-RWJBarnabas Health, Livingston, New Jersey, USA
| | - Christina H Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, USA
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Lin PC, Liu CY, Tzeng IS, Hsieh TH, Chang CY, Hou YT, Chen YL, Chien DS, Yiang GT, Wu MY. The impact of holiday season and weekend effect on traumatic injury mortality: Evidence from a 10-year analysis. Tzu Chi Med J 2022; 35:69-77. [PMID: 36866355 PMCID: PMC9972933 DOI: 10.4103/tcmj.tcmj_20_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/07/2022] [Accepted: 06/20/2022] [Indexed: 11/04/2022] Open
Abstract
Objectives Trauma is one of the leading causes of death and its incidence increases annually. The "weekend effect" and "holiday season effect" on traumatic injury mortality remain controversial, whereby traumatic injury patients admitted during weekends and/or holiday season have a higher risk of in-hospital death. The present study is aimed to explore the association between "weekend effect" and "holiday season effect" and mortality in traumatic injury population. Materials and Methods This retrospective descriptive study included patients from the Taipei Tzu Chi Hospital Trauma Database between January 2009 and June 2019. The exclusion criterion was age of < 20 years. The primary outcome was the in-hospital mortality rate. The secondary outcomes included intensive care unit (ICU) admission, ICU re-admission, length of stay (LOS) in the ICU, ICU admission duration ≥ 14 days, total hospital LOS, total hospital LOS ≥ 14 days, need for surgery, and re-operation rate. Results In this study, 11,946 patients were included in the analysis, and 8143 (68.2%) patients were admitted on weekdays, 3050 (25.5%) on weekends, and 753 (6.3%) on holidays. Multivariable logistic regression revealed that the admission day was not associated with an increased risk of in-hospital mortality. In other clinical outcome analyses, we found no significant increase in the risk of in-hospital mortality, ICU admission, ICU LOS ≥ 14 days, or total LOS ≥ 14 days in the weekend and holiday season groups. The subgroup analysis showed that the association between holiday season admission and in-hospital mortality was noted only in the elderly and shock condition populations. The holiday season duration did not differ in terms of in-hospital mortality. Longer holiday season duration was also not associated with an increased risk of in-hospital mortality, ICU LOS ≥14 days, and total LOS ≥14 days. Conclusion In this study, we did not find any evidence that weekend and holiday season admissions in the traumatic injury population were associated with an increased risk of mortality. In other clinical outcome analyses, there was no significant increase in the risk of in-hospital mortality, ICU admission, ICU LOS ≥ 14 days, or total LOS ≥ 14 days in the weekend and holiday season groups.
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Affiliation(s)
- Po-Chen Lin
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan,Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chi-Yuan Liu
- Department of Orthopedic Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan,Department of Orthopedics, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - I-Shiang Tzeng
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Tsung-Han Hsieh
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Chun-Yu Chang
- Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan,Department of Anesthesiology, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yueh-Tseng Hou
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan,Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yu-Long Chen
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan,Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Da-Sen Chien
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan,Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Giou-Teng Yiang
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan,Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Meng-Yu Wu
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan,Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan,Address for correspondence: Dr. Meng-Yu Wu, Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289, Jianguo Road, Xindian District, New Taipei, Taiwan. E-mail:
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Van Essen D, Vergouwen M, Sayre EC, White NJ. Orthopaedic trauma on the weekend: Longer surgical wait times, and increased after-hours surgery. Injury 2022; 53:1999-2004. [PMID: 35331476 DOI: 10.1016/j.injury.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/06/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Darren Van Essen
- Section of Orthopaedics, Cumming School of Medicine, University of Calgary, 2500 University Drive, NW T2N 1N4, Calgary, AB, Canada
| | - Martina Vergouwen
- Section of Orthopaedics, Cumming School of Medicine, University of Calgary, 2500 University Drive, NW T2N 1N4, Calgary, AB, Canada
| | - Eric C Sayre
- Arthritis Research Canada, 5591 Number 3 Rd, V6 × 2C7, Richmond, BC, Canada
| | - Neil J White
- Section of Orthopaedics, Cumming School of Medicine, University of Calgary, 2500 University Drive, NW T2N 1N4, Calgary, AB, Canada.
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