Impact of a Dedicated Pediatric Orthopaedic Trauma Room on Efficiency Metrics and Complications: A Systematic Review and Meta-analysis.

UNLABELLED: Optimal timing of fracture care is critical in delivering high value care to pediatric populations requiring specialized surgical teams. Several studies have assessed outcomes of operatively managed fractures after implementation of a dedicated orthopaedic trauma operating room (DOTR) in pediatrics; therefore, we sought to perform a meta-analysis of the existing literature.Using preferred reporting items for systematic reviews and meta-analyses (PRISMA) methodology, a systematic review was conducted for comparative studies reporting outcomes of any pediatric fracture treated operatively before and after implementation of a DOTR and those comparing fractures managed in DOTR versus non-DOTR operating rooms. Meta-analyses of pooled data were performed for time from admission to surgery, hospital length of stay, surgical duration, open vs closed reductions of supracondylar fractures, and surgical complication rate.897 studies were identified, 12 of which underwent full-text review, with 4 included in the current review. 743 and 831 patients with supracondylar fractures were included in the DOTR-available and DOTR-unavailable groups, respectively. 78 and 192 patients with diaphyseal femur fractures were included in the DOTR-available and DOTR-unavailable groups, respectively. In patients with supracondylar humerus fractures in the DOTR-available group, time to OR was decreased (mean difference = -1.43 h, 95% CI: -2.66 to -0.19, P = .023), operative duration was modestly decreased (mean difference = -1.50 min, 95% CI: -1.58 to -1.42, P < .001), and hospital length of stay was decreased (mean difference = -4.07 h, 95% CI: -5.75 to -2.39, P < .001), with no differences in proportion of open reduction and complication rates. In patients with diaphyseal femur fractures in the DOTR-available group, time to OR was decreased (mean difference = -2.58 h, 95% CI: -3.12 to -2.03, P < .001), though operative duration was increased (mean difference = 13.7 min, 95% CI: 3.12 - 24.29, P = .01). No significant differences were seen in the length of stay or complication rate.Pooled analyses demonstrated the availability of a first start dedicated orthopaedic trauma room resulted in modest improvements in efficiency metrics in supracondylar fractures with no increased risk of complications. Aligning with the orthopaedic trauma association recommendation, an early start model may be a safe, feasible, and beneficial means to improve hospital operations and care of pediatric trauma patients.

KEY CONCEPTS: (1)A first start dedicated orthopaedic trauma room resulted in modest improvements in efficiency metrics in supracondylar fractures with no increased risk of complications.(2)An early start model may be a safe, feasible and beneficial means to improve hospital operations and care of pediatric trauma patients.

LEVEL OF EVIDENCE: III.