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Journal of orthopaedic trauma


OBJECTIVE: To assess the outcomes of elderly hip fracture surgeries performed 12 months before and 12 months after the implementation of a daily 6am-9am DOTR at a Level II community trauma center.

DESIGN: Retrospective cohort study SETTING:: Level II academic trauma center PATIENTS:: A total of 431 consecutive trauma patients undergoing surgical management of isolated low energy hip fractures from January 1, 2018, to December 31, 2019.

INTERVENTION: Implementation of a 6am-9am DOTR Monday through Friday MAIN OUTCOME MEASURES:: Time to surgery, number of cases performed after-hours, surgical time, 90-day morbidity and mortality, and time to therapy.

RESULTS: Retrospective analysis showed that despite a 24% increase in surgical hip fracture volume, implementation of a part-time DOTR led to a decrease in after-hours surgery (32.4% vs. 19.6%; P=0.008) and patients requiring the intensive care unit postoperatively (7% vs. 3.8%; P=0.036). Surgeries performed after-hours were longer compared to surgeries performed during the daytime (82.0 minutes vs. 68 minutes; P=0.003) and had more complications (pneumonia, pulmonary embolism and surgical site infection; P=0.002, 0.047, 0.024, respectively).

CONCLUSIONS: Our results show that a part-time DOTR in a community Level II hospital is associated with improvement in patient care.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

PubMed ID



ePub ahead of print