Allocating operating room time in orthopaedic trauma: a survey in medical ethics

Introduction Allocation of operating room time is a challenging dilemma that surgeons frequently confront. When deciding upon a daily caseload, the surgeon may consider clinical, logistical, and social factors. Although previous studies have outlined guiding principles, there is no universal algorithm for prioritizing surgical patients. Our study aims to learn which factors orthopaedic trauma surgeons use when determining case priority.Methods A survey regarding the allocation of operating room time was administered to orthopaedic trauma surgeons from the community and members of the Southeastern Fracture Consortium. Questions included a list of characteristics and a series of theoretical case scenarios to be ranked according to perceived priority.Results Of the participating surgeons, 92% practiced at an academic center and 89.7% at a level 1 trauma center. Of the case characteristics, "severity of orthopaedic problem" was most frequently ranked as most important versus "social pressure from family members," which was most frequently ranked as least important in case priority. The coefficient of concordance among respondents was 0.427 for individual case characteristics versus 0.287 for the theoretical scenarios. The average rate of agreement among respondents was 31.9 +/- 19% for individual factors versus 36.3 +/- 8.9% in the clinical vignettes.Conclusions A consensus exists regarding severity of the presenting orthopaedic problem being the most important factor when considering case priority. The lower agreement in the clinical vignettes indicates a strong interplay between the multiple factors in a case. Survey commentary suggests that outside factors - training, experience, politics, the team available - also play a role in a surgeon's decision on case priority. Level of evidence: IV.Conclusions A consensus exists regarding severity of the presenting orthopaedic problem being the most important factor when considering case priority. The lower agreement in the clinical vignettes indicates a strong interplay between the multiple factors in a case. Survey commentary suggests that outside factors - training, experience, politics, the team available - also play a role in a surgeon's decision on case priority. Level of evidence: IV.