TY  - JOUR
PY  - 2016//
TI  - Off-hour surgery among orthopedic subspecialties at an urban, quaternary-care, Level 1 trauma center
JO  - Journal of hand surgery (American volume)
A1  - Lans, Amanda
A1  - Janssen, Stein J.
A1  - Ring, David
SP  - 1153
EP  - 1158
VL  - 41
IS  - 12
N2  - PURPOSE: We sought to determine and quantify which subspecialties of orthopedic surgeons are operating off hours in an urban, quaternary-care, level 1 trauma center. <br><br>MATERIALS AND METHODS: We used our clinical registry to identify 43,211 orthopedic surgeries performed between January 2008 and December 2011. Our outcome measures were the number and proportion of off-hour surgeries performed as well as the number and proportion of off-hours per subspecialty. The denominators were the total number of surgeries and the total number of surgical hours worked per subspecialty. Subspecialties-based on the primary surgeon who performed the surgery-were arthroplasty, foot and ankle, hand, pediatrics, shoulder, spine, sports, orthopedic trauma, and orthopedic oncology. <br><br>RESULTS: A total of 2,431 (5.6%) surgeries were off-hours; the overall ratio of off-hour to on-hour surgeries was 1 to 17. There was a difference in the proportion of off-hour surgeries performed among orthopedic subspecialties: trauma (ratio, 1:5) and pediatric specialists (ratio, 1:5) had the lowest ratio, and shoulder (ratio, 1:152) and sports (ratio, 1:98) specialists the highest. The total number of surgical hours among all specialties was 59,026; of these hours, 3,833 (6.5%) were off-hour. The ratio of off-hour to on-hour surgical hours was 1 to 14. There was a difference in proportion of hours worked off-hour among orthopedic subspecialties; the ratios were greatest for trauma (1:5) and hand (1:5) specialists and the least for shoulder (1:157) and sports (1:92) specialists. Seven percent of hand surgery cases were off-hour, and 16% of the total surgical hours worked by hand surgeons were off-hour. <br><br>CONCLUSIONS: In an urban, academic, level 1 trauma and microvascular replantation regional referral hospital, there is a large difference in off-hour surgical volume and duration among orthopedic subspecialties: trauma, pediatric, and hand surgeons performed more off-hour work than their colleagues, with hand and pediatric surgeons the most likely to be working at night. CLINICAL RELEVANCE: These data can inform how we organize, value, and incentivize off-hour care.<br><br>Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.<p />  <p>Language: en</p>
LA  - en
SN  - 0363-5023
UR  - http://dx.doi.org/10.1016/j.jhsa.2016.09.017
ID  - ref1
ER  -