Outpatient surgery refers to the process of a patient presenting to hospital, undergoing surgery, and returning home the same day. There is an ever-increasing proportion of outpatient surgeries being completed. Selection criteria for outpatient surgery have broadened, including in paediatric trauma cases. Challenges to delivering urgent surgical care to paediatric patients include psychosocial consequences of awaiting for surgery (i. e.: having to be admitted and removed from their home environment), prolonged preoperative fasting, and disruption to family functioning. It was proposed that implementing designated operating room (OR) time for paediatric orthopedic trauma cases could mitigate some of these negative aspects and improve cost efficiency. Retrospective analysis of paediatric patients undergoing orthopaedic trauma surgeries at a Level 1 Paediatric Trauma centre from January 2023 to January 2024 was completed. Comparison between those weeks with designated pediatric orthopedic trauma OR time and weeks without was completed. Weeks without designated time resulted in patients having surgery from the surgical emergency board or in a previously scheduled elective OR resulting in elective cases being postponed. The number of inpatient cases that could have been completed as outpatient cases if OR trauma time had been available, and utilization of the allocated OR time were assessed. Additionally, we compared the hospital cost data associated between both groups. There were 18 (35%) weeks with a designated OR time allocated to paediatric orthopaedic trauma. On average 7. 7 children/week required urgent orthopaedic surgery. There were 419 cases completed during this time period. Of those, 176 (42%) were completed in dedicated trauma time. For the weeks without designated paediatric orthopaedic OR time, 91 (31%) of the admitted patients could have been completed as outpatients; whereas when designated OR time was available this reduced to 7. 1% of patients (7 of the 176 cases). On average 6. 7 hours/week were utilized in the designated paediatric trauma OR when available, resulting in a 95% utilization rate. There is a statistically significant (P < 0. 05) decrease in the number of elective OR hours used for trauma cases when a trauma OR was available (from 2. 8 hours on weeks without trauma time to 1. 3 hours for weeks with trauma time). For a case completed in the dedicated trauma OR, the average hospital cost was 3, 254. 85. This increased to 4, 502. 91 for cases done outside of these rooms. This led to an estimated hospital cost savings of 219, 659. 09 for the 176 trauma time cases. Allocating designated OR time for paediatric orthopaedic outpatient trauma surgeries has been implemented at our institution. Results demonstrate a reduction in the number of inpatients due to an increase in the number of surgeries being completed on an outpatient basis. The utilization rate of designated OR time was excellent and more OR time remained available for elective cases. Additionally, cost data demonstrated significant cost savings when cases were done during dedicated trauma time. Further analysis is required to determine the optimal amount of OR time which should be dedicated to paediatric orthopaedic trauma and the impact of seasonal fluctuations in paediatric trauma volume.
Banchard et al. (Wed,) studied this question.