Outcomes Associated with Various Iterations of The Dedicated Orthopaedic Trauma Room

Purpose: Scheduling urgent, orthopaedic trauma cases has long been a challenge for health care institutions. Traditionally, these cases are scheduled for an operating room (OR) slot in the middle of the night, by "bumping" elective cases to later in the day, by adding a case on after-hours, or by delaying the case for several days until an OR becomes available. As a solution to the challenges facing traditional scheduling modules, trauma centers around the country have instituted the use of a dedicated orthopaedic trauma room (DOTR). While there are multiple studies analyzing the effects of DOTRs on various outcomes, there is not a centralized review of these studies. This paper will serve as a review of the various models of the DOTR as well as the effect of the DOTR on after-hours procedures, time to surgery (TTS), duration of surgery (DOS), length of stay (LOS), cost, and surgical complications. Methods: An extensive review of the literature was performed through PubMed and Embase. Studies were included in the review if they were published in English, involved clinical research, and reported the use of a dedicated operating room at a regular interval throughout the week, specifically for orthopaedic trauma. 15 studies were found to meet the eligibility criteria. Results: We found a decrease across all studies measuring incidence of after-hours procedures before and after the implementation of a DOTR. Regarding mean TTS after the implementation of a DOTR, 3 out of 11 studies found a statistically significant decrease, 3 out of 11 studies found a statistically significant increase, and 5 out of 11 studies found no significant difference. Regarding mean DOS after the implementation of a DOTR, 2 out of 9 studies found a statistically significant decrease, 1 out of 9 studies found a statistically significant increase, and 6 out of 9 studies found no significant difference. Regarding mean LOS after the implementation of a DOTR, 6 out of 12 studies found a statistically significant decrease, 1 out of 12 studies found a statistically significant increase, and 5 out of 12 studies found no significant difference. Multiple studies reported financial outcomes favoring the DOTR. In addition, multiple studies reported favorable findings after the implementation of a DOTR regarding decreased mortality, unplanned reoperations, and postoperative ICU admission. Conclusions: This review suggests that DOTRs have a significant effect on decreasing the number of after hour procedures, decreasing cost, and decreasing morbidity and mortality of orthopaedic trauma patients. There is variability in the data regarding the effect on time to surgery, duration of surgery, and length of stay.