Association of Organizational Pathways With the Delay of Emergency Surgery

• Published in: JAMA network open 2023-04, Vol.6 (4), p.e238145-e238145
• Main Authors: Lepercq, Delphine, Gauss, Tobias, Godier, Anne, Bellet, Julie, Bouhours, Guillaume, Bouzat, Pierre, Cailliau, Emeline, Cook, Fabrice, David, Jean-Stéphane, Drame, Fatou, Gauthier, Marvin, Lamblin, Antoine, Pottecher, Julien, Tavernier, Benoit, Garrigue-Huet, Delphine
• Format: Article
• Language: English
• Subjects: Adult; Child; Cohort analysis; Cohort Studies; Critical Care Medicine; Emergencies; Female; Humans; Life Sciences; Male; Middle Aged; Online Only; Operating Rooms; Original Investigation; Prospective Studies; Surgery; Tertiary Care Centers
• ISSN: 2574-3805; 2574-3805
• DOI: 10.1001/jamanetworkopen.2023.8145

Delayed admission of patients with surgical emergencies to the operating room occurs frequently and is associated with poor outcomes. In France, where 3 distinct organizational pathways in hospitals exist (a dedicated emergency operating room and team [DET], a dedicated operating room in a central operating theater [DOR], and no dedicated structure or team [NOR]), neither the incidence nor the influence of delayed urgent surgery is known, and no guidelines are available to date. To examine the overall frequency of delayed admission of patients with surgical emergencies to the operating room across the 3 organizational pathways in hospitals in France. This prospective multicenter cohort study was conducted in 10 French tertiary hospitals. All consecutive adult patients admitted for emergency surgery from October 5 to 16, 2020, were included and prospectively monitored. Patients requiring pediatric surgery, obstetrics, interventional radiology, or endoscopic procedures were excluded. Emergency surgery. The main outcome was the global incidence of delayed emergency surgery across 3 predefined organizational pathways: DET, DOR, and NOR. The ratio between the actual time to surgery (observed duration between surgical indication and incision) and the ideal time to surgery (predefined optimal duration between surgical indication and incision according to the Non-Elective Surgery Triage classification) was calculated for each patient. Surgery was considered delayed when this ratio was greater than 1. A total of 1149 patients were included (mean [SD] age, 55 [21] years; 685 [59.9%] males): 649 in the DET group, 320 in the DOR group, and 171 in the NOR group (missing data: n = 5). The global frequency of surgical delay was 32.5% (95% CI, 29.8%-35.3%) and varied across the 3 organizational pathways: DET, 28.4% (95% CI, 24.8%-31.9%); DOR, 32.2% (95% CI, 27.0%-37.4%); and NOR, 49.1% (95% CI, 41.6%-56.7%) (P