Orthopaedic surgical treatment waiting time for acute musculoskeletal trauma patients attended at Muhimbili Orthopaedic Institute, Dar-Es-Salaam

Abstract

Background: Waiting time for acute musculoskeletal trauma surgery has been used as a measure of institutional efficiency. Delay in  operating on trauma patients leads to increased morbidity, mortality and reports have shown negative impacts and additional costs for  the hospitals besides inconvenience to patients and their families.

Objectives: To determine the extent and causes of delay of  orthopaedic surgical treatment among acute musculoskeletal trauma patients at Muhimbili Orthopaedic Institute.

Methods: A cross- sectional study on two hundred and eighty patients who met the inclusion criteria. Modified Lankester tool was used to assess the  patients from the emergency department and classified into A or B according to the urgency of their surgery. Data was analysed using  predictors of surgical delay beyond 24 hours were identified by logistic regression analysis.

Results: The mean age of these trauma  patients was 28±15 years of whom a large proportion (79.6%) were male. Lankester group A accounted for 77.5% of the patients  recruited. The mean waiting time for orthopaedic surgery for Lankester A and B respectively was 9±5 and 12±6 hours whereby 65.4% of Lankester group A and 9.5% of Lankester B had missed their optimal target time.

Conclusion: Only about a third (34.6%) of emergency  patients were operated in less than 6 hours after admission. The most common cause of this delay was lack of theatre slots while the  presence of comorbidities predicted delay of more than 24 hours.

Recommendations: There should be more theatres allocated for  emergency surgeries and there should be a physician present in the emergency on-call team to manage the co-morbid conditions to   reduce their waiting time.