Impact of a Daytime Operating Room on Resource Use and Outcomes in Emergency General Surgery

Abstract

Introduction: The implementation of acute care surgery (ACS) services has not been standardized. There is no known “best” model or optimal infrastructure required to care for emergency general surgery (EGS) patients. The addition of dedicated daytime operative room (OR) resources may increase patient access and reduce overnight operations.

Methods: We performed a retrospective cohort study of patients who underwent emergency appendectomy, cholecystectomy, or hernia repair at a tertiary care center from Feb 1, 2015 to Dec 31, 2018. A daytime ACS room was implemented on Jan 18, 2017, dividing patients into two cohorts: the “Pre-Access” period prior to and “Post-Access” period after implementation. Resources were allocated to the ACS room only if cases were booked by 430 PM the day prior. Outcomes included after-hour ORs (5 pm – 7 am), time to OR, time of scheduled ORs (AM or PM) and relevant patient outcomes.

Results: Over 4-years, 925 patients underwent appendectomy (42%), cholecystectomy (50%) or hernia repair (8%) on an emergent basis. There was a 49% increase in volume in the Post-Access period, without an increase in time to OR [14 h, IQR 38 for both groups], after-hours OR (42.1% v 42.1%, p=0.99) or timing of ORs (28.3% v 29.1% AM start and 29.4% v 28.7% PM start, p=0.96). There was no change in hospital length of stay [2 d, IQR 4 v 3 d, IQR 4, p=0.39] or complication rates (14% v 18%, p=0.15). On subgroup analysis, only delayed cholecystectomies for gallstone pancreatitis (GSP) showed a reduction in after-hours ORs (13% v 0%, p=0.03) and an increase in AM OR start times (43% v 71%, p=0.02), suggesting that pre-scheduled cases are most affected by this OR allocation model.

Conclusion: Despite a significant increase in volume there was no increase in after-hours resource utilization, hospital length of stay, or worse patient outcomes. The addition of an ACS room improved daytime access for GSP but not for other diagnoses. Dedicated infrastructure results in efficient use of resources and the ability to manage increasing patient volumes. Efficiency may be further improved by dedicated staffing of ACS rooms.