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. 2024 Apr;76(2):687-698.
doi: 10.1007/s13304-023-01668-4. Epub 2024 Jan 8.

The Operating Room management for emergency Surgical Activity (ORSA) study: a WSES international survey

Belinda De Simone  1 , Vanni Agnoletti  2 , Fikri M Abu-Zidan  3 , Walter L Biffl  4 , Ernest E Moore  5 , Elie Chouillard  6 , Federico Coccolini  7 , Massimo Sartelli  8 , Mauro Podda  9 , Salomone Di Saverio  10 , Haytham Kaafarani  11 , Zsolt J Balogh  12 , Miklosh Bala  13 , Ari K Leppäniemi  14 , Andrew W Kirkpatrick  15 , Emmanouil Pikoulis  16 , Kemal Rasa  17 , Chiara Rosato  18 , Robert Sawyer  19 , Luca Ansaloni  20 , Nicola de'Angelis  21 , Dimitris Damaskos  22 , Philip F Stahel  23 , Yoram Kluger  24 , Raul Coimbra  25 ; ORSA Collaborative; Fausto Catena  2   26
Collaborators, Affiliations

The Operating Room management for emergency Surgical Activity (ORSA) study: a WSES international survey

Belinda De Simone et al. Updates Surg. 2024 Apr.

Abstract

Background: 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.

Method: 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.

Results: 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.

Conclusions: 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.

Keywords: Emergency surgery; Health system; Management; Operating room; Planning; Scheduling; Trauma surgery; Triage.

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