Surgical Emergency Flows and Delays in Admission to the Operating Room

Study Overview
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Brief Summary
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French hospitals treat non-elective surgery according to three organizational models: in a dedicated multi-specialty emergency operative room (OR), in a dedicated OR within a specialized surgical platform or in any available OR from a list of non-dedicated OR. Some triage algorithms for the classification of non-elective surgery have been described but are not routinely applied. The rate of delay in the management of non-elective surgery in France is not known. Reducing this delay decreased mortality and morbidity in urgent surgery (McIsaac D, et al., CMAJ 2017). Optimizing the flow of non-elective surgery represents a major challenge. The main objective of this study is to determine the rate of delay in admission to the OR in emergency surgery through a multicenter prospective observational study in France. All patients requiring urgent surgical management (<72 hours) will be included. The ideal time for surgery was previously defined by surgeons according to the NEST classification (NEST 1: within minutes; NEST 2: < 1 hour; NEST 3: < 4 hours; NEST 4: < 12 hours; NEST 5: < 48 hours; NEST 6: < 72 hours). For each patient, the ratio between the observed time (actual Time To Surgery [aTTS] ) and the ideal time (ideal Time To Surgery [iTTS]) will be determined. The delay is identified by aTTS/iTTS ratio >1.

Official Title
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Flows of Emergency Surgery and Delay in Admission to the Operating Room: a Multicenter Prospective Observational Study in France

Conditions
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Surgery, Emergencies, Postoperative Complications

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: any patient meeting the Following two criteria at least 18 ys old decision for unplanned surgery (which should be performed within 72 hours according to the protocol) in one of the following hospitals: Lille University hospital, Grenoble University hospital, Strasbourg University hospital, Paris University hospitals (Européen Georges Pompidou, Beaujon, H. Mondor), Lyon University hospital (Hôpital E. Herriot, Lyon Sud), Angers University hospital, Anthony Private hospital). Exclusion Criteria: obstetrics interventional radiology endoscopies

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of OR admission delay (delay = aTTS / iTTS > 1) | hours | 30 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| OR Admission delay according to the three organizational model | hours | 30 days | 
| OR Admission delay according to the period of work (day, night, and week-end) | hours | 30 days | 
| OR Admission delay according to the NEST classification | hours | 30 days | 
| delays related to organisational causes | hours | 30 days | 
| delays related to material causes | hours | 30 days | 
| delays related to human causes | hours | 30 days | 
| Impact of the delay on ICU length of stay | days | 30 days | 
| Impact of the delay on hospital length of stay | days | 30 days | 
| Impact of the delay on mortality |  | 30 days | 
| Impact of the delay on morbidity |  | 30 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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delay, organization