Frequency distribution and coordination of emergency operations in German hospitals (FACE) : Analysis in 26 hospitals depending on the level of care

• Published in: Die Anaesthesiologie 2022-06, Vol.71 (6), p.426-436
• Main Authors: Janda, Matthias, Karaca, O, Brosin, A, Reuter, D A, Schuster, M
• Format: Article
• Language: ger
• Subjects: Anesthesia; Anesthesiology; Emergencies; Female; Hospitals, University; Humans; Operating Rooms; Pregnancy
• ISSN: 2731-6866
• DOI: 10.1007/s00101-021-01064-w

Timely emergency surgery is vital as this often has a direct impact on morbidity and mortality. The joint recommendations of the German Associations of Anesthesiologists (BDA), Surgeons (BDC), and Operating Room Management (VOp.M) for coordinative implementation have been available since 2016: N0 (surgery immediately), N1 (surgery start in the next free operating room), N2 (surgery start ≤ 6 h), N3 (surgery at the end of the elective schedule), N4/Urgent (surgery within 12-24 h). The aim of this study was to describe the situation of care in German hospitals of different sizes for the first time using routine data. The data were collected in 26 hospitals with different levels of care over a period of 10 days. The frequency distribution of the individual emergency categories and the duration from the notification of the operation to the start of anesthesia or surgery were examined for the hospital as a whole and for the four operating departments with a typically high ratio of emergencies: general surgery, trauma surgery, gynecology/obstetrics and urology. A total of 1603 emergency surgical interventions were analyzed. The number of N0 cases was very low due to the specific entity of these emergencies, N1 made up approximately 13-15% of emergencies and categories N2-N4/Urgent comprised approximately 25-32% of emergencies each. The average duration between the notification of the operation and the start of anesthesia or surgery was (min): N0 20.7 ± 14.3 and 43.6 ± 31.8, N1 61.5 ± 48.7 and 90.1 ± 56.1, N2 187.9 ± 152.0 and 220.5 ± 153.4, N3 394.5 ± 392.3 and 428.3 ± 397.9 and N4/Urgent 494.8 ± 484.4 and 519.6 ± 486.6, respectively. The distribution of the emergency categories did not differ significantly between community hospitals compared to tertiary care hospitals, including university hospitals (p = 0.731) and also the duration between notification and start of anesthesia and operation was similar. Significant differences depending on the service level were only found for N1 until the start of anesthesia and for N3 until the start of anesthesia and of surgery. General surgery classified as N3 has a significantly shorter implementation time in community hospitals compared to tertiary care hospitals, including university hospitals, both at the start of anesthesia (mean 287.8 min versus 417.1 min; p = 0.045) and at the start of surgery (mean 316.3 min versus 459.0 min; p = 0.032). The implementation of trauma surgery emergencies classified as N1 took place,