3 years ago

Pediatric Supracondylar Humerus Fractures: Does After-Hours Treatment Influence Outcomes?

Vorhies, John S., Bishop, Julius A., Paci, Gabrielle M., Tileston, Kali R.
Objective: To compare the outcomes of pediatric supracondylar humerus fractures treated during daytime hours to those treated after-hours. Design: Retrospective. Setting: Academic Level I trauma center. Patients/Participants: Two hundred ninety-eight pediatric patients treated with surgical reduction and fixation of closed supracondylar fractures were included. Intervention: Seventy-seven patients underwent surgery during daytime hours (06:00–15:59 on weekdays). One hundred eighty-six patients underwent surgery after-hours (16:00–05:59 on weekdays and any surgery on weekends or holidays). Main Outcome Measures: Surgeon subspecialty, operative duration, and radiographic and clinical outcomes, including range of motion and carrying angle, were extracted from the patient medical records. Results: There were no patient-related demographic differences between the daytime hours and after-hours groups. Daytime surgery was more likely to be performed by a pediatric orthopaedic surgeon than after-hours surgery. Fractures treated after-hours had more severe injury patterns. After-hours surgery was not independently associated with rate of open reduction, operative times, complications, achievement of functional range of motion, or radiographic alignment. A late-night surgery subgroup analysis demonstrated an increased rate of malunion in patients undergoing surgery between the hours of 23:00 and 05:59. Conclusions: There is no difference in the operative duration or outcomes after surgical treatment of pediatric supracondylar humerus fractures performed after-hours when compared with daytime surgery. However, late-night surgery performed between 23:00 and 05:59 may be associated with a higher rate of malunion. Surgeons can use these data to make better-informed decisions about the timing of surgery in this patient population. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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