The Factors That Affect Operating Room Start Time for Pediatric Femoral Shaft Fractures
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: The operating room start time (ORST) for pediatric femoral fractures is a health-care quality metric used for hospital rankings and accreditation. Factors affecting ORST remain unclear. This study aimed to evaluate the demographic and clinical factors associated with gold-standard (early) ORST (<18 hours) versus delayed ORST (≥18 hours) for pediatric femoral fractures. METHODS: A retrospective review was conducted of 216 pediatric patients with a femoral shaft fracture admitted to the emergency department (ED) at a pediatric Level-I trauma hospital from 2021 to 2023. Patient demographic and clinical data were analyzed to identify significant factors associated with ORST. Immediate postoperative outcomes were compared across ORST groups. RESULTS: In multivariable models, race, ED admission time, comorbidities, and surgery type affected ORST (p < 0.05). Compared with White patients, patients of other racial or ethnic groups, including Hispanic, Black, Asian, and multiracial patients, had 2.4 times higher odds of delayed ORST. Compared with midnight to 6 a.m. ED admissions, the odds of delayed ORST were 6.6 times higher for ED admissions between 6 a.m. and noon and 9.2 times higher for ED admissions between noon and 6 p.m. Patients with comorbidities were 4.7 times more likely to experience delayed surgery compared with healthy patients. Patients who underwent open reduction and internal fixation (ORIF) were 2.5 times as likely as patients who underwent closed reduction (CR) with a spica cast to have delayed ORST. Delayed ORST was associated with longer hospital stay (median, 71 hours) compared with early ORST (median, 41 hours), but not with immediate complications. CONCLUSIONS: ED admission time, race, method of transfer, comorbidities, and procedure type were associated with ORST for pediatric femoral fractures. Longer ORST led to a disproportionately longer hospital stay. LEVEL OF EVIDENCE: Prognostic Level IV . See Instructions for Authors for a complete description of levels of evidence.
Institutions: Boston Children's Hospital, Harvard University
Language: English
Subfield: Emergency Medical Services
Field: Health Professions
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4408972837