Department of Emergency and Trauma Surgery, Villeneuve St Georges Academic Hospital, Villeneuve St Georges, France.
Department of General and Emergency surgery, Level I Trauma Center, Bufalini Hospital, Cesena, Italy.
Updates Surg. 2024 Apr;76(2):687-698. doi: 10.1007/s13304-023-01668-4. Epub 2024 Jan 8.
Despite advances and improvements in the management of surgical patients, emergency and trauma surgery is associated with high morbidity and mortality. This may be due in part to delays in definitive surgical management in the operating room (OR). There is a lack of studies focused on OR prioritization and resource allocation in emergency surgery. The Operating Room management for emergency Surgical Activity (ORSA) study was conceived to assess the management of operating theatres and resources from a global perspective among expert international acute care surgeons.
The ORSA study was conceived as an international web survey. The questionnaire was composed of 23 multiple-choice and open questions. Data were collected over 3 months. Participation in the survey was voluntary and anonymous.
One hundred forty-seven emergency and acute care surgeons answered the questionnaire; the response rate was 58.8%. The majority of the participants come from Europe. One hundred nineteen surgeons (81%; 119/147) declared to have at least one emergency OR in their hospital; for the other 20/147 surgeons (13.6%), there is not a dedicated emergency operating room. Forty-six (68/147)% of the surgeons use the elective OR to perform emergency procedures during the day. The planning of an emergency surgical procedure is done by phone by 70% (104/147) of the surgeons.
There is no dedicated emergency OR in the majority of hospitals internationally. Elective surgical procedures are usually postponed or even cancelled to perform emergency surgery. It is a priority to validate an effective universal triaging and scheduling system to allocate emergency surgical procedures. The new Timing in Acute Care Surgery (TACS) was recently proposed and validated by a Delphi consensus as a clear and reproducible triage tool to timely perform an emergency surgical procedure according to the clinical severity of the surgical disease. The new TACS needs to be prospectively validated in clinical practice. Logistics have to be assessed using a multi-disciplinary approach to improve patients' safety, optimise the use of resources, and decrease costs.
尽管在外科患者的管理方面取得了进步和改善，但急诊和创伤外科仍与高发病率和死亡率相关。这可能部分归因于手术室（OR）中确定性手术管理的延迟。目前缺乏专注于急诊手术 OR 优先级和资源分配的研究。设计：ORSA 研究旨在从全球角度评估手术室管理和资源利用情况，来自国际急危重症外科专家。方法：ORSA 研究设计为国际网络调查。问卷由 23 个多项选择题和开放性问题组成。数据收集时间为 3 个月。参与调查是自愿和匿名的。结果：147 名急诊和急性护理外科医生回答了问卷；应答率为 58.8%。大多数参与者来自欧洲。119 名外科医生（81%；119/147）表示其医院至少有一个急诊 OR；对于另外 20/147 名外科医生（13.6%），没有专门的急诊手术室。46 名（68%；147/147）外科医生在白天使用择期 OR 进行急诊手术。70%（104/147）的外科医生通过电话规划急诊手术。结论：在国际上，大多数医院没有专门的急诊 OR。通常会推迟或甚至取消择期手术以进行急诊手术。验证有效的通用分诊和调度系统以分配急诊手术程序是当务之急。最近提出并通过 Delphi 共识验证了新的急性护理手术时间（TACS），作为一种根据手术疾病的临床严重程度及时进行急诊手术的清晰且可重复的分诊工具。需要前瞻性验证新的 TACS 在临床实践中的应用。需要采用多学科方法评估物流，以提高患者安全性、优化资源利用并降低成本。
