Evolving Trauma Demands: Trends in Orthopaedic Case Volume and Major Trauma Centre Service Adaptations, 2016-2024.

Background Healthcare services in the UK are becoming increasingly stretched, attempting to match the demands of an ageing and growing population, with Trauma and Orthopaedics being no exception. New national targets to reduce waiting times have resulted in additional operating capacity for elective services; however, trauma services have not seen an equivalent expansion. Aim This retrospective operational audit aims to quantify changes in trauma workload in a Major Trauma Centre between 2016 and 2024 and assess how the service has adapted to accommodate these changes, to aid service planning. Methods A retrospective operational audit was conducted in a UK Major Trauma Centre using archived daily trauma meeting lists (n=237) and operation records (n=1376), from June and November of 2016, 2019, 2021 and 2024. Linear regression and a sign test were used to test for significance. From this data, we extrapolated ways in which the service has adapted to meet the changes in demand. Results Whilst the number of trauma operations did not change considerably between 2016 (n=344) and 2024 (n=359, a 4.36% increase), there was a substantial increase in many time-sensitive operations including a 47% increase (from n=34 to n=50) in open fracture operations, a 70% increase (from n=20 to n=34) in femoral fracture operations, and an 11% increase (from n=90 to n=100) in hip fracture operations. Upper limb fracture operations increased by 46% (from n=41 to n=60); however, ankle fracture operations only saw a 2.9% increase (from n=35 to n=36). Limited data meant individual operation types did not show significant increases; however, the overall upward trend of all fracture types studied was significant (p=0.016). These changes were accommodated for by reallocating several procedures to elective lists, including arthroscopic repairs, prosthetic joint infections, and removal of metalwork. In 2016, nine trauma operations were conducted in elective or additional theatre lists. This rose to 88 in 2021 when spare elective lists were available following the COVID-19 pandemic, before falling to 45 in 2024 after full elective services returned. The mean average number of patients discussed in daily trauma meetings in June 2024 increased by 19% (from 28.7±6.6 in 2016 to 34.1±6.9 in 2024) and 25% in November (from 23.9±3.3 in 2016 to 29.8±7.8). The average number of operations listed for the day increased by 22% (from 6.01±2.55 in 2016 to 7.34±2.75) in 2024. Conclusions The substantial increase in volume of time-sensitive trauma patients has forced the service to adapt through changes in theatre utilisation. To create sufficient space in trauma theatres, many procedures have migrated to elective lists. Spare theatre time on elective lists is regularly used to complete trauma cases when the trauma workload exceeds capacity. Ad hoc additional theatres are more regularly opened for trauma when demand exceeds capacity. Patient care is already being impacted through increased delays to treatment. Trauma volume is predicted to continue rising with the growing ageing population, and without additional trauma lists or semi-elective ambulatory lists, trauma services will soon become overwhelmed, undermining the ability to provide safe and timely care for patients.