Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb 2;13(1):1888.
doi: 10.1038/s41598-023-28921-5.

Adverse events are not increased by controlled delay in surgery of acute upper extremity fractures

Torkki Matias  1 , Somersalo Axel  2 , Kautiainen Hannu  3   4 , Ax Maarit  5 , Kiviranta Ilkka  2 , Paloneva Juha  6   7
Affiliations

Adverse events are not increased by controlled delay in surgery of acute upper extremity fractures

Torkki Matias et al. Sci Rep. .

Abstract

Management of the operative treatment of fractures is challenged by daily variation in patient flow. For upper limb fractures there has recently been an increasing tendency to temporarily discharge the patient to wait for a daytime operation to be performed during the next few days. The objective of this study was to study the safety of controlled delay in surgery. Upper limb fractures (N = 1 944) treated in a level 2 trauma center from 2010 to 2016 were identified and included in this retrospective cohort study with 5-year follow-up. Delay in surgery, inpatient time, readmissions, ED revisits and mortality were analyzed. Depending on the nature of the injury, controlled delay to surgery was implemented. Urgency of surgery was coded as green (2 days to 2 weeks) yellow (8-48 h) or red (less than 8 h). Harms and benefits to the groups were compared. Controlled delay of surgery (median delay of 5 days 7 h) was applied in 1 074 out of 1 944 fractures. The number of revisits to the emergency department (11.1% vs. 17.9-24.1%, p < 0.001) or hospital readmissions for any reason (0.99 per 100 person years in the delayed group vs. 3.74 and 4.35 in the non-delayed groups, p < 0.001) was no higher in patients with delayed (green) compared to those with non-delayed (yellow and red) operations. Inpatient time was significantly lower in the delayed group than other groups (IRR 2.31-3.36, (p < 0.001)). The standardized mortality ratio was 0.83 (CI 0.57-1.22) in the delayed group vs. 1.49 (CI 1.17-1.90) and 1.61 (CI 1.16-2.23) in the non-delayed groups. Controlled delay in upper limb trauma surgery did not lead to increased readmissions or mortality and was associated with reduced inpatient time.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Mean length of hospital stay (days). Urgency of emergency operation: red = 0–8 h; yellow = 8–48 h; green = 2–14 days. Whiskers represent 95% confidence intervals.
Figure 2
Figure 2
Cumulative mortality. Urgency of emergency operation: red = 0–8; yellow = 8–48 h; green = 2–14 days.
See this image and copyright information in PMC

References

    1. Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37:691–697. doi: 10.1016/j.injury.2006.04.130. - DOI - PubMed
    1. Somersalo A, Paloneva J, Kautiainen H, et al. Incidence of fractures requiring inpatient care. Acta Orthop. 2014;85:525–530. doi: 10.3109/17453674.2014.908340. - DOI - PMC - PubMed
    1. Somersalo A, Paloneva J, Kautiainen H, et al. Increased mortality after upper extremity fracture requiring inpatient care. Acta Orthop. 2015;86:533–557. doi: 10.3109/17453674.2015.1043833. - DOI - PMC - PubMed
    1. Ax M, Reito A, Koskimaa M, et al. Scheduled emergency trauma operation: The green line orthopedic trauma surgery process of care. Scand. J. Surg. 2018 doi: 10.1177/1457496918803015. - DOI - PubMed
    1. Leppaniemi A, Jousela I. A traffic-light coding system to organize emergency surgery across surgical disciplines. Br. J. Surg. 2014;101:e134–e140. doi: 10.1002/bjs.9325. - DOI - PubMed