Session X - Polytrauma II

Sat., 10/22/05 Polytrauma II, Paper #43, 9:18 am

Is "After Hours" Surgery Associated with Adverse Outcomes?

William M. Ricci, MD (a,e-Smith+Nephew); John R. Schwappach, MD (n); Ross K. Leighton, MD (n); Kevin J. Coupe, MD (n); Michael C. Tucker, MD (n);
Washington University School of Medicine at Barnes-Jewish Hospital,
St. Louis, Missouri, USA

Purpose: Treatment of fractures is sometimes performed after normal daytime operating hours under less than ideal conditions. We studied the consequence of performing operations under such conditions.

Methods: 203 consecutive patients with either a femoral or tibial shaft fracture (OTA 32 or 42) treated with intramedullary nailing were included in this prospective, IRB-approved study. Patients were divided into those treated "after hours"4:00 pm to 6:00 am (AH group)and those treated during"daytime hours" from 6:00 am to 4:00 pm (DH group). These groups were subdivided into Femur-AH (n=55), Femur-DH (n=44), Tibia-AH (n=48), and Tibia-DH (n=56). The demographic and fracture characteristics were similar between the groups (p>0.05).

Results: Operative times were shorter for the Femur-AH and Tibia-AH groups compared to the Femur-DH and Tibia-DH groups (p<0.02). Radiation exposure was similar for after hours surgery compared to daylight hours surgery for both the femur and tibia (p>0.05). Surgery after hours was associated with more unplanned reoperations than surgery during daylight hours (p<0.02). More than twice as many patients treated after hours required removal of prominent hardware (p<.01).

Conclusions: Our results indicate that nailing of femoral and tibial shaft fractures after hours was associated with increased complications (despite demographics and fracture severity similar to those treated in normal daytime hours) but not increased operative time or radiation exposure. The less than ideal conditions associated with after hours surgery (such as surgeon fatigue and personnel unfamiliar with the procedure) might contribute to the increased incidence of complications, especially the increased rate of reoperation for prominent hardware. Increased daytime operating time for trauma surgery has the potential to reduce complication rates.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.