A propensity score-adjusted retrospective analysis of after-hours and daytime surgery for Gartland type III pediatric supracondylar humeral fracture

The optimal surgical timing for pediatric supracondylar humeral fractures has been deliberated. Although the recent trend is to postpone surgery until the daytime, the effect of after-hours surgery on outcomes requires further elucidation. Thus, we aimed to evaluate whether the timing of surgery for pediatric supracondylar humeral fractures affects the outcomes. The data of 135 pediatric patients who underwent surgery for Gartland type III supracondylar humeral fractures at a single trauma center were retrospectively analyzed. Depending on the time of admission to the operating room, the patients were divided into daytime and after-hours surgery cohorts. Nearest-neighbor propensity score matching was conducted, and outcomes were compared between the matched cohorts. The primary outcome was defined as reduction failure, including revision surgery. Secondary outcomes included the operative time, indication for open reduction, and complications. Each matched cohort consisted of 48 patients, with a mean age of 6.6 ± 2.6 years. The after-hours surgery resulted in more frequent reduction failures than the daytime surgery (21% vs. 4%, P < 0.05). No significant differences were observed in the secondary outcomes. In the post hoc analysis, where the matched cohorts were stratified by the presence of supervising orthopedic trauma surgeons, reduction failure rates showed no statistically significant difference between daytime and after-hours surgery. This propensity score-adjusted retrospective study revealed that reduction failures occurred more frequently in after-hours surgeries than in daytime surgeries for pediatric supracondylar humeral fractures. The absence of supervising surgeons may have contributed to the poorer outcome of after-hours surgeries.