What A Change A Year Makes: Orthopedic Case Volume After ACS-Level II Trauma Status

Background This study compares orthopedic trauma case volumes at an urban hospital before and after ACS Level II Trauma designation. We hypothesized a significant increase in both volume & case complexity following this designation which impacts hospital operations and personnel needs. Methods This retrospective study analyzed prospectively collected data on orthopedic trauma cases at an urban Level II center for the year before and after accreditation. Data collected included injury/surgery details, case urgency and surgery day/weekend timing. Data analysis was conducted using SPSS (IBM Corp., Armonk, NY) and Microsoft Excel. Independent t-tests assuming unequal variances were performed for comparison. A p-value of < 0.05 was considered statistically significant. Results There was a significant increase in overall case volume (P < 0.001), including urgent (P < 0.001) & emergent cases (P = 0.002). Significant growth was observed in periarticular tibial plateau (P < 0.001) and femoral shaft fractures (P < 0.001). An increase in distal femur (P = 0.073), open tibial shaft (P = 0.189), closed tibial shaft (P = 0.05), and periarticular pilon fractures (P = 0.210) were also observed. Significant increases were noted in ballistic fractures (P < 0.001) and open fractures (P < 0.001). A notable rise in cases occurred on both weekends (P = 0.049) and weekdays (P < 0.001), demonstrating the impact of the accreditation. Conclusion Our data demonstrates transition to an ACS Level II Trauma Center led to increases in caseload and complexity. This highlights the need for adjustments in operating room access, staffing and scheduling to accommodate these demands. This also represents an increase in opportunities for trainees, supporting the importance of trauma center access in education. Further studies into the impact of change in ACS designation level and how it affects case volume distribution across are warranted.