Kym D, Kaur J, Pham NS, Klein E, Langner JL, Wang E, Vorhies JS. Effectiveness of an early operating room start time in managing pediatric trauma. World J Orthop 2023; 14(7): 516-525 [PMID: 37485431 DOI: 10.5312/wjo.v14.i7.516]
Corresponding Author of This Article
John Schoeneman Vorhies, MD, Assistant Professor, Department of Orthopaedic Surgery, Stanford University School of Medicine, 453 Quarry Rd, 3rd Floor, MC 5658, Palo Alto, CA 94304, United States. john.vorhies@stanford.edu
Research Domain of This Article
Orthopedics
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Jul 18, 2023; 14(7): 516-525 Published online Jul 18, 2023. doi: 10.5312/wjo.v14.i7.516
Effectiveness of an early operating room start time in managing pediatric trauma
Dan Kym, Japsimran Kaur, Nicole Segovia Pham, Eric Klein, Joanna Lind Langner, Ellen Wang, John Schoeneman Vorhies
Dan Kym, Japsimran Kaur, Nicole Segovia Pham, Joanna Lind Langner, John Schoeneman Vorhies, Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, CA 94304, United States
Eric Klein, Lucile Packard Children’s Hospital, Palo Alto, CA 94304, United States
Ellen Wang, Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, United States
Author contributions: Kym D, Kaur J, Pham NS, Klein E, Langner JL, Wang E, and Vorhies JS contributed to the research, writing, and revision of the manuscript.
Institutional review board statement: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted an IRB waiver by the Ethics Committee of Stanford University (IRB No. 46989).
Informed consent statement: This project is not a randomized clinical trial. Per our Institutional Review Board, this study did not need signed consent from participants.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: John Schoeneman Vorhies, MD, Assistant Professor, Department of Orthopaedic Surgery, Stanford University School of Medicine, 453 Quarry Rd, 3rd Floor, MC 5658, Palo Alto, CA 94304, United States. john.vorhies@stanford.edu
Received: February 22, 2023 Peer-review started: February 22, 2023 First decision: April 13, 2023 Revised: May 10, 2023 Accepted: June 6, 2023 Article in press: June 6, 2023 Published online: July 18, 2023 Processing time: 146 Days and 10.5 Hours
Abstract
BACKGROUND
The timing of operative treatment for pediatric supracondylar humerus fractures (SCHF) and femoral shaft fractures (FSF) remains controversial. Many fractures previously considered to be surgical emergencies, such as SCHF and open fractures, are now commonly being treated the following day. When presented with an urgent fracture overnight needing operative treatment, the on-call surgeon must choose whether to mobilize resources for a late-night case or to add the case to an elective schedule of the following day.
AIM
To describe the effect of a program allowing an early operating room (OR) start for uncomplicated trauma prior to an elective day of surgery to decrease wait times for surgery for urgent fractures admitted overnight.
METHODS
Starting in October 2017, patients were eligible for the early slot in the OR at the discretion of the surgeon if they were admitted after 21:00 the previous night and before 05:00. We compared demographics and timing of treatment of SCHF and FSF treated one year before and after implementation as well as the survey responses from the surgical team.
RESULTS
Of the 44 SCHF meeting inclusion criteria, 16 received treatment before implementation while 28 were treated after. After implementation, the mean wait time for surgery decreased by 4.8 h or 35.4% (13.4 h vs 8.7 h; P = 0.001). There were no significant differences in the operative duration, time in the post anesthesia care unit, and wait time for discharge. Survey results demonstrated decreased popularity of the program among nurses and anesthesiologists relative to surgeons. Whereas 57% of the surgeons believed that the program was effective, only 9% of anesthesiologists and 16% of nurses agreed. The program was ultimately discontinued given the dissatisfaction.
CONCLUSION
Our findings demonstrate significantly reduced wait times for surgery for uncomplicated SCHF presenting overnight while discussing the importance of shared decision-making with the stakeholders. Although the program produced promising results, it also created new conflicts within the OR staff that led to its discontinuation at our institution. Future implementations of such programs should involve stakeholders early in the planning process to better address the needs of the OR staff.
Core Tip: This study describes the effect of a program allowing an early operating room start for uncomplicated trauma prior to an elective day of surgery to decrease wait times for surgery for urgent fractures admitted overnight. After implementation, the mean wait time for surgery decreased by 4.8 h or 35.4%. Survey results demonstrated decreased popularity of the program among nurses and anesthesiologists relative to surgeons. Our findings demonstrate significantly reduced wait times for surgery for uncomplicated pediatric supracondylar humerus fractures presenting overnight while discussing the importance of shared decision-making with the stakeholders.
