From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Saddik, Nenshi, Engels); the Department of Surgery, Western University, London, Ont. (Vogt, Allen); the Department of Surgery, William Osler Health System, Brampton, Ont. (Van Heest, Saleh); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); the Department of Surgery, University of British Columbia, Vancouver, BC (Joos, Hameed); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball); and the Department of Surgery, Indiana University, Indianapolis, Ind. (Murphy).
From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Saddik, Nenshi, Engels); the Department of Surgery, Western University, London, Ont. (Vogt, Allen); the Department of Surgery, William Osler Health System, Brampton, Ont. (Van Heest, Saleh); the Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); the Department of Surgery, University of British Columbia, Vancouver, BC (Joos, Hameed); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball); and the Department of Surgery, Indiana University, Indianapolis, Ind. (Murphy)
Can J Surg. 2023 Jan 3;66(1):E13-E20. doi: 10.1503/cjs.008120. Print 2023 Jan-Feb.
Access to the operating room (OR) is variable among emergency general surgery (EGS) services, with some having dedicated EGS ORs, and others only a shared queue. Currently in Canada, only a limited number of acute care surgery services have dedicated daytime operating room (OR) access; hence, we aimed to describe the burden of after-hours EGS operating in Canada and differences associated with OR access.
In this multicentre retrospective cohort study, we used data from a previously conducted study designed to evaluate nonappendiceal, nonbiliary disease across 8 Canadian hospitals. We performed a secondary analysis to describe booking priorities and timing of operative interventions, compare sites with and without access to a dedicated EGS daytime OR, and identify differences in morbidity and mortality based on timing of operative intervention.
Among 1244 patients, operations were performed during weekday daytime in 521 cases (41.9%), in the evening in 279 (22.4%), on the weekend in 293 (23.6%) and overnight in 151 (12.1%). Operating room booking priority was more than 2 hours to 8 hours in 657 cases (52.8%), more than 8 hours to 24 hours in 334 (26.9%) and more than 24 hours to 48 hours in 253 (20.3%). Substantial variation in booking priority was observed for the same preoperative diagnoses. Sites with dedicated EGS ORs performed a greater proportion of cases during daytime versus overnight compared to sites without dedicated EGS ORs (198/237 [83.5%] v. 323/435 [74.2%], = 0.006). No significant differences in outcome were found between cases performed during the daytime, evening and overnight.
We found considerable variation in OR booking priority within the same preoperative diagnoses among EGS patients in Canada. Sites with dedicated EGS ORs performed more cases during weekday daytime compared to sites without dedicated EGS ORs; however, this study showed no evidence of compromised outcomes based on OR timing.
急诊普通外科（EGS）服务的手术室（OR）资源获取情况存在差异，有些机构有专门的 EGS OR，而有些机构只有共享队列。目前，加拿大只有少数急性护理外科服务机构拥有专门的日间手术室（OR）资源；因此，我们旨在描述加拿大非阑尾、非胆道疾病的 EGS 手术在非工作时间的工作量，并分析 OR 资源获取情况与这些工作量的关系。
在这项多中心回顾性队列研究中，我们使用了之前一项研究的数据，该研究旨在评估加拿大 8 家医院的非阑尾、非胆道疾病。我们进行了二次分析，以描述手术预约的优先级和手术干预的时间，比较有和没有专门 EGS 日间 OR 资源的机构之间的差异，并根据手术干预的时间来确定发病率和死亡率的差异。
在 1244 例患者中，521 例（41.9%）在工作日白天、279 例（22.4%）在晚上、293 例（23.6%）在周末和 151 例（12.1%）在夜间进行了手术。657 例（52.8%）的手术预约优先级超过 2 小时至 8 小时，334 例（26.9%）超过 8 小时至 24 小时，253 例（20.3%）超过 24 小时至 48 小时。对于相同的术前诊断，手术预约优先级存在很大差异。有专门 EGS OR 的机构在白天和夜间进行的手术比例明显高于没有专门 EGS OR 的机构（198/237[83.5%]比 323/435[74.2%]， = 0.006）。在白天、晚上和夜间进行的手术在结果方面没有显著差异。
我们发现加拿大 EGS 患者的同一术前诊断的 OR 预约优先级存在相当大的差异。有专门 EGS OR 的机构在工作日白天进行的手术比例明显高于没有专门 EGS OR 的机构；然而，本研究没有证据表明 OR 时间会对结果产生不利影响。
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