THE EFFECT OF EMERGENCY SPINAL CASES ON A T&O TRAUMA OPERATING LIST IN A TRAUMA UNIT

Emergency spinal surgeries often require urgent theatre access, which can impact scheduling and cause cancellations of other operations. This study investigates the extent to which spinal emergencies affect orthopaedic trauma case scheduling at our unit.

We retrospectively analysed prospectively collected data, looking at all T&O surgeries cancelled because of emergency spinal surgeries, performed between 2023 and 2024. We analysed all trauma cases listed on the theatre scheduling software (ORMIS) that were cancelled during the same period. Cases were included if the reason for cancellation was due to spinal emergencies, or where the cancellation reason was ambiguous. Cases were excluded if the reason was clearly unrelated (e.g., not starved, no bed, etc). Over the defined period, 254 emergency spinal surgeries took place, resulting in a total of 207 trauma patients experienced cancellations due to spinal emergency surgical cases. Among them, 7 patients (3.4%) were cancelled twice due to spinal cases, and 14 patients (6.8%) were converted to non-operative management due to delays. Subspecialist input was required in 125 cases (60.4%), with individual subspecialty involvement ranging from 50% to 100%. Of the cancelled patients, 82 (39.6%) remained as inpatients whilst awaiting rescheduled surgery, with subspecialty inpatient rates ranging from 4.2% to 100%. The median inpatient wait time for surgery was 1 day (IQ25% = 1, IQ75% = 4). For patients scheduled as ‘to come in’ (TCI), the median delay before surgery was 3 days (IQ25% = 1, IQ75% = 5).

Emergency spinal cases significantly impact trauma theatre scheduling, leading to cancellations, prolonged inpatient stays, and delayed surgeries. A substantial proportion of affected patients required subspecialist care, underlining the complexity of trauma management in the context of competing emergency demands. Strategies to increase flexibility in theatre scheduling, or a dedicated spinal trauma theatre, would likely reduce disruption and improve patient outcomes across all subspecialties.