Advantages of a Dedicated Orthopaedic Trauma Operating Room for Diaphyseal Femur Fractures.

Abstract

To examine the impact of instituting a dedicated orthopaedic trauma operating room (DOTOR) at a Level I trauma center on diaphyseal femur fracture management. Retrospective cohort study. Regional, university-based Level I trauma center. Trauma patients 18-65 years of age who presented between October 2016 and December 2018 (approximately 1 year before and after implementation of the DOTOR) and underwent surgery for diaphyseal femur fractures. One hundred twenty-eight patients met eligibility criteria for inclusion: 60 were treated before and 68 after implementation of the DOTOR. Implementation of a DOTOR in October 2017. Percentage of external fixation versus intramedullary nailing, time from emergency department visit to definitive fixation, duration of surgery, and hospital length of stay. The only significant difference in patient demographics between the before and after groups was mechanism of injury (P = 0.003). Percentage of external fixators as an initial procedure decreased from 15% to 2.9% (P = 0.024). Time to definitive fixation with intramedullary nail decreased from 1083 minutes to 659 minutes (P = 0.002). There was no significant change in median operative time of intramedullary nailing (P = 0.573). Although not statistically significant, hospital length of stay decreased from 7 days to 5.5 days after implementation (P = 0.158). Cost analysis revealed annual cost savings of more than $261,678 for diaphyseal femur fractures alone by implementing a DOTOR. For diaphyseal femur fractures, instituting a DOTOR at a Level I trauma center reduced the percentage of patients requiring a 2-stage fixation, reduced the time to definitive fixation, and yielded cost savings. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.