A Dedicated Trauma Operating Room for Hand Surgery Reduces After-Hours Cases and Costs without Affecting Wait Times
Bibliographic record
Abstract
BACKGROUND: After-hours hand trauma care is associated with surgeon fatigue, a higher risk of complications, and increased staffing costs. Dedicated trauma operating rooms (DTORs) have been established in orthopaedic and trauma surgery to improve access to care and patient outcomes. The purpose of this study was to measure the impact of a DTOR for hand surgery on the proportion of after-hours cases and wait times from consultation to surgery at a Canadian urban tertiary-care center. METHODS: This retrospective cohort study included adult patients undergoing hand trauma surgery during 2 periods: before DTOR implementation, from August 1, 2018, to January 31, 2020 (n = 599), and after DTOR implementation, from August 1, 2022, to January 31, 2024 (n = 541). The main outcomes were the proportion of emergency cases performed after hours and the wait times from consultation to surgery. A post hoc analysis examined total hospital costs. Multivariable logistic regression was used to estimate associations with binary outcomes, and multivariable negative binomial regression was used to estimate associations with continuous outcomes. Other outcomes, including caseload, surgical complications, and revision surgeries, were assessed using univariate analysis. RESULTS: After DTOR implementation, after-hours cases decreased from 18% (109 of 599) to 8% (45 of 541). Adjusting for covariates, DTOR implementation was associated with fewer emergency hand surgeries being performed after hours (odds ratio, 0.47 [95% confidence interval (CI), 0.23 to 0.95]; p = 0.03). The median wait times were similar before and after DTOR implementation: 6 days before implementation and 8 days after it (rate ratio, 1.03 [95% CI, 0.91 to 1.16]; p = 0.64). DTOR implementation was associated with a 19% adjusted reduction in total hospital costs: in Canadian dollars, $2,578.66 before DTOR implementation and $2,220.98 after it (rate ratio, 0.81 [95% CI, 0.78 to 0.84]; p < 0.001). The hand trauma caseload was similar (p = 0.09) before and after DTOR implementation. Complications became less frequent after DTOR implementation (reduced from 5% to 2%; p = 0.03), whereas revision rates did not change (10% and 11%; p = 0.70). CONCLUSIONS: DTOR implementation was associated with fewer after-hours surgeries, lower complication rates, and meaningful hospital cost savings, without increasing wait times or revision rates. These findings support integrating DTORs to improve operational efficiency and patient outcomes in hand trauma care. LEVEL OF EVIDENCE: Economic and Decision Analysis Level III . See Instructions for Authors for a complete description of levels of evidence.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".