Allocating operating room resources to an acute care surgery service does not affect wait-times for elective cancer surgeries: a retrospective cohort study

Abstract

IntroductionAcute care surgical services provide timely comprehensive emergency general surgical care while optimizing the use of limited resources. At our institution, 50% of the daily dedicated operating room (OR) time allocated to the Acute Care Emergency Surgery Service (ACCESS) came from previous elective general surgery OR time. We assessed the impact of this change in resource allocation on wait-times for elective general surgery cancer cases.MethodsWe retrospectively reviewed adult patients who underwent elective cancer surgeries in the pre-ACCESS (September 2009 to June 2010) and post-ACCESS (September 2010 to June 2011) eras. Wait-times, calculated as the time between booking and actual dates of surgery, were compared within assigned priority classifications. Categorical and continuous variables were compared using chi-square and Mann–Whitney U tests respectively.ResultsA total of 732 cases (367 pre-ACCESS and 365 post-ACCESS) were identified, with no difference in median wait-times (25 versus 23 days) between the eras. However, significantly fewer cases exceeded wait-time targets in the post-ACCESS era (p <0.0001). There was a significant change (p = 0.027) in the composition of cancer cases, with fewer breast cancer operations (22% versus 28%), and more colorectal (41% versus 32%) and hepatobiliary cancer cases (5% versus 2%) in the post-ACCESS era.ConclusionThese results suggest that shifting OR resources towards emergency surgery does not affect the timeliness of surgical cancer care. This study may encourage more centres to adopt acute care surgical services alongside their elective or subspecialty practices.

Association of delay of urgent or emergency surgery with mortality and use of health care resources: a propensity score–matched observational cohort study

“…In hip fracture surgery, delay is associated with morbidity and mortality, 6,7 but for other surgeries, the effect of delay on outcomes is unclear. [8][9][10][11][12][13] Because it is very expensive to expand or reorganize operating room resources to improve access, [14][15][16] understanding the relation between delay and outcomes for all types of emergency surgery is needed.…”

A RAND-Modified Delphi on Key Indicators to Measure the Efficiency of Living Kidney Donor Candidate Evaluations

“…Fourth, although the decision to start testing may vary between programs, we expect these differences to be small relative to the overall time frame of the evaluation process (days rather than months). Similar dates have been used by some transplant programs (e.g., "decision to proceed" with a donor) and in other areas for quality improvement (e.g., the "decision to treat" for estimating wait times) (25)(26)(27). Fifth, although we expect the final terms and indicators will be useful to quality improvement efforts outside of Canada, we wait to see if any region-specific changes will be needed in their future implementation.…”

Processes of Health Care Delivery, Education, and Provider Satisfaction in Acute Care Surgery: A Systematic Review

“…In this week, the surgeon suspends his or her elective practice to focus on ACS during the day and shares overnight call responsibilities. [10][11][12] Dedicated OR time was variable among the sites and was reported in six studies. 10,[13][14][15][16][17] y Level of Evidence (LOE) rated on a scale of 1 to 5 (1 -RCT or meta-analyses of RCTs; 2 -studies using concurrent controls without true randomization or meta-analyses of such studies; 3 -studies using retrospective controls; 4 -studies without a control group; 5 -studies not directly related to the specific patient/population).…”

“…Eight papers reported on length of hospital stay, 11,17,[21][22][23][24][25] five papers described ED LOS, 11,17,21,22,24 six papers reported on the time lapsed between admission to the ED to the OR/time to surgery, 10,11,20,21,24,25 and five papers reported the percentage of operations performed after-hours 13,16,18,20,26 (Tables 3 and 4).…”