Orthopedic Surgery Preferable During Daytime Hours

A new study that compared after-hours and daytime orthopedic surgery success rates has found that those patients who have after-hour surgeries risk a slightly higher rate of necessary follow-up surgeries.

Researchers from the Washington University School of Medicine (St. Louis, MO, USA) conducted a prospective study that tracked the results of 203 patients with either a femoral or tibial shaft fracture that were treated with intramedullary nail fixation. The patients were primarily divided into two groups: a daytime group, defined as those who had surgery between 06:00 and 16:00 hours, and an after-hours group of those patients who had surgery between 16:00 and 06:00. All patients were treated with the same type of femoral antegrade, retrograde, or tibial nail fixation with reaming. Data for fracture healing, complications, operative time, and fluoroscopy time were collected prospectively.

Study data suggested similar healing time and intraoperative radiation exposure for the two groups. However, the data also showed some notable differences in outcomes between after-hours and daytime surgeries; the after-hours group had more unplanned follow-up operations than the daytime group; removal of painful hardware was more frequent in an after-hours group (27%) than the corresponding daytime group (3%); and operative times were slightly shorter in the after-hours groups. After-hours femoral nail fixation was associated with an increased frequency for removal of painful hardware, which according to the researchers could be related to technical errors associated with nonideal conditions and shorter operative times. According to the authors, the results suggest that daytime orthopedic trauma surgery has the potential to reduce minor complication rates associated with intramedullary nail fixation. The study was published in the September 2009 issue of The Journal of Bone and Joint Surgery.

"Although everyone wants to be treated immediately, it may be in a patient's best interest to wait until morning. The reality is that the on-call night surgical team may not be well rested as it is likely they had just finished a normal day shift,” said lead author William Ricci, M.D., an associate professor of orthopedic surgery and chief of the orthopedic trauma service at the Washington University School of Medicine. "Many hospitals in the United States do have a dedicated night team of orthopedic surgeons who otherwise are without daytime responsibilities for those instances when treatment must be immediate,” added Dr. Ricci. "For nonemergent fracture care, sufficient daytime resources should be made available to avoid unnecessary night-time surgery.”

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Washington University School of Medicine