Identifying Reasons for Nonmedical Delays in Fixation of Femur, Pelvis, and Acetabular Fractures at a Level 1 Trauma Center

Abstract

Objective: To identify reasons for nonmedical delays in femur, pelvis, and acetabular fracture fixation at an institution with a dedicated orthopaedic trauma room (DOTR) and an early appropriate care practice model. Design: Retrospective review of a prospective registry. Setting: Urban Level 1 trauma center. Patients/Participants: Two hundred ninety-four patients undergoing 313 procedures for 226 femur, 63 pelvis, and 42 acetabular fractures. Intervention: Definitive fixation. Main Outcome Measurements: Reasons for delays in fixation after hospital day 2. Results: Delays occurred in 12.5% of procedures (39/313), with 7.7% (24/313) having medical delays and 4.8% (15/313) having nonmedical delays. Nonmedical delays were most commonly due to the operating room being at-capacity (n = 6) and nonpelvic trauma specialists taking weekend call (n = 5). Procedures with nonmedical delays were associated with younger age (median difference −16.0 years, 95% confidence interval [CI], −28 to −5.0; P = 0.006), high-energy mechanisms (proportional difference [PD] 58.5%, 95% CI, 37.0–69.7; P < 0.0001), Thursday through Saturday hospital admission (PD 30.3%, 95% CI, 5.0–50.0; P < 0.0001), pelvis/acetabular fractures (PD 51.8%, 95% CI, 26.7–71.0%; P < 0.0001), and external fixation (PD 33.0%, 95% CI, 11.8–57.3; P < 0.0001). Conclusion: Only 4.8% of procedures experienced nonmedical delays using an early appropriate care model and a DOTR. Nonmedical delays were most commonly due to 2 modifiable factors—the DOTR being at-capacity and nonpelvis trauma specialists taking weekend call. Patients with nonmedical delays were more likely to be younger, with pelvis/acetabular fractures, high-energy mechanisms, external fixation, and to be admitted between Thursday and Saturday. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.