Multicenter study finds better results for IM nailing done in daytime vs. after hours

Fracture fixation surgeries performed after hours rather than during the daytime have been associated with more unplanned reoperations and a 27% rate of subsequent hardware removal compared to 3% for those completed during the day, according to a recent investigation.

The study, published this month in The Journal of Bone and Joint Surgery, also found slightly shorter operative times for the after-hours procedures, according to the study’s results.

William M. Ricci, MD, chief of the Orthopaedic Trauma Service at Washington University School of Medicine in St. Louis, and colleagues at U.S. and Canadian centers prospectively studied 203 consecutive patients with femoral or tibial shaft fractures treated with intramedullary (IM) nail fixation during daytime hours or after hours.

They compared the two groups’ outcomes, defining daytime surgery hours as between 6 a.m. and 4 p.m. and after-hours as 4 p.m. to 6 a.m.

“The results of the study suggest the system is working fairly well and it is not always best to rush a patient to the OR in the middle of the night,” Ricci said in a press release.

He noted that immediate surgery is still indicated for all emergent medical conditions where the time factor is critical.

Both groups of patients that were studied had similar treatments, healing times, nonunion rates, incidence of infection and radiation exposure relative to their femoral and tibial fractures, leading investigators to attribute the notable differences observed in the two groups’ outcomes to the different times of day their procedures were performed.

“It may be in the 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,” Ricci, lead author of the study, said in the release.

Investigators concluded that technical errors relative to the after-hours procedures, such as nonideal conditions and shorter surgical times, could account for the increased rates of hardware removal seen.

“An increase in the allocated amount of daytime operative time for orthopedic trauma surgery has the potential to reduce minor complication rates for intramedullary nail fixation,” they wrote in their abstract.

Reference:
Ricci WM, Gallagher B, Brandt A, et al. Is after-hours orthopaedic surgery associated with adverse outcomes? J Bone Joint Surg (Am). 2009;91:2067-2072. doi: 10.2106/JBJS.H.00661.