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. 2022 Jul 1;36(7):321.
doi: 10.1097/BOT.0000000000002319.

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

Corinne Cloud  1 , Bronson Fong  1 , Christopher Bloise  2 , Claudia Leonardi  3 , Peter C Krause  1 , Olivia C Lee  1
Affiliations

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

Corinne Cloud et al. J Orthop Trauma. .

Abstract

Objective: To examine the impact of instituting a dedicated orthopaedic trauma operating room (DOTOR) at a Level I trauma center on diaphyseal femur fracture management.

Design: Retrospective cohort study.

Setting: Regional, university-based Level I trauma center.

Patients: 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.

Intervention: Implementation of a DOTOR in October 2017.

Main outcome measures: Percentage of external fixation versus intramedullary nailing, time from emergency department visit to definitive fixation, duration of surgery, and hospital length of stay.

Results: 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.

Conclusions: 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.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Conflict of interest statement

The authors report no conflict of interest.

Comment in

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