ORTHOPOD Study Results

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ORTHOPOD  is a multi-centre collaborative study investigating the performance of trauma services, characteristics and distribution of injuries across the United Kingdom. It emerged out of growing concerns among members within the trauma community that injuries with recommended time to surgery windows were being missed and the delivery of trauma care within a nationalised health service was suboptimal.

The study ran for 10 consecutive weeks, across 90 hospitals, including 23,138 general trauma cases and 709 weeks’ worth of theatre capacity entries. From this, two key works were produced.

The first paper described trauma performance in its generality. It highlighted significant variability in the delivery of trauma services, both operative demand and list provision. On average, 1.73 cases were completed per trauma theatre session. Those injuries associated with performance metrics and incentives, for example open and hip fractures, showed least variation and shortest time to surgery. Patients waiting for surgery at the start of each week also fluctuated greatly within and between hospitals, highlighting an opportunity to develop intra-regional networks to better distribute trauma workload to effectively utilise all available trauma theatre capacity.

The second paper described day-case trauma services or lack thereof. Regular dedicated day-case trauma lists were rare – national average of 0 lists per week. Day-case trauma accounted for nearly one third (29.1%) of overall trauma burden but only 6 hospitals had access to a daily day-case trauma list. This placed a heavy reliance on general trauma lists to manage inpatient and outpatient caseload. Furthermore, the day-case trauma patient was identified as disadvantaged as they typically waited longer for surgery and had higher cancellation rates compared to inpatients whilst still causing more disruption to scheduled elective operating.

There is a common message in these two papers, the need for interconnectivity - whether it be an equitable distribution of general trauma between neighbouring trusts or regional collaborative effort at creating a hub and spoke model of dedicated day-case trauma centres and pooled day-case patients. More than ever, greater cooperation within our trauma community is needed to address the ever-expanding trauma burden. 

First paper publication details:

Wei N, Baldock TE, Elamin-Ahmed H, et al. ORthopaedic trauma hospital outcomes - Patient operative delays (ORTHOPOD) Study: The management of day-case orthopaedic trauma in the United Kingdom [published online ahead of print, 2023 Mar 24]. Injury. 2023;S0020-1383(23)00288-7. doi:10.1016/j.injury.2023.03.032

Second paper due to be soon.