Determinants of Delays in Non-traumatic Emergency Abdominal Surgeries: A Prospective Analysis

Hamza Hafiani *

Department of Anesthesiology and Intensive Care, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University Rabat, Morocco.

Rania Elmouhib

Department of Visceral Surgery I, Faculty of Medicine and Pharmacy,Mohammed V Military Hospital, Mohammed V University Rabat, Morocco.

Wiam Eljellouli

Department of Anesthesiology and Intensive Care, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University Rabat, Morocco.

Moncef Choubhi

Department of Anesthesiology and Intensive Care, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University Rabat, Morocco.

Taoufik Kachani

Department of Anesthesiology and Intensive Care, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University Rabat, Morocco.

Khalil Abouelalaa

Department of Anesthesiology and Intensive Care, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University Rabat, Morocco.

*Author to whom correspondence should be addressed.


Abstract

Introduction: Delays in non-traumatic emergency abdominal surgeries can significantly impact patient outcomes. Identifying the factors contributing to these delays is crucial for improving surgical efficiency and patient care. This study aims to prospectively analyze the determinants of delays in non-traumatic emergency abdominal surgeries and their effects on clinical outcomes.

Methods: A prospective observational study was conducted on patients requiring non-traumatic emergency abdominal surgery over a one-year period. Data were collected on demographic variables, clinical characteristics, and time intervals from hospital admission to surgery. Factors such as diagnostic procedures, availability of surgical staff, operating room logistics, and preoperative optimization were analyzed. Statistical analysis was performed to identify significant predictors of surgical delays.

Results: Out of 217 patients, 40% experienced significant delays (>6 hours) from admission to surgery. Key factors contributing to delays included prolonged diagnostic workup (35%), limited operating room availability (25%), and preoperative medical optimization (20%). Delays were associated with increased postoperative complications (15% in delayed group vs. 8% in non-delayed group, p<0.05) and extended hospital stay (mean of 7 days in delayed group vs. 4 days in non-delayed group, p<0.05).

Discussion: The study highlights that diagnostic delays and operating room logistics are major contributors to surgical postponements. Addressing these issues through streamlined diagnostic protocols and improved operating room management can potentially reduce delays. Enhanced preoperative planning and resource allocation are also essential to mitigate the impact of delays on patient outcomes.

Conclusion:Delays in non-traumatic emergency abdominal surgeries are influenced by multiple factors, including diagnostic processes, operating room availability, and preoperative medical optimization. Reducing these delays through targeted interventions can improve patient outcomes and optimize surgical care.

Keywords: Non-traumatic emergency abdominal surgery, surgical delay, diagnostic workup, operating room availability, preoperative optimization, patient outcomes


How to Cite

Hafiani, Hamza, Rania Elmouhib, Wiam Eljellouli, Moncef Choubhi, Taoufik Kachani, and Khalil Abouelalaa. 2024. “Determinants of Delays in Non-Traumatic Emergency Abdominal Surgeries: A Prospective Analysis”. Journal of Advances in Medicine and Medical Research 36 (7):187-97. https://doi.org/10.9734/jammr/2024/v36i75496.

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References

Gale SC, Shafi S, Dombrovskiy VY, Arumugam D, Crystal JS. The public health burden of emergency general surgery in the United States: A 10-year analysis of the Nation wideIn patient Sample--2001 to 2010. J Trauma Acute Care Surg. 2014, Aug;77(2):202-8. DOI:10.1097/TA.0000000000000362. PMID: 25058242.

Smith SA, Yamamoto JM, Roberts DJ, Tang KL, Ronksley PE, Dixon E, Buie WD, James MT. Weekend surgical care and postoperative mortality: A systematic review and meta-analysis of cohort studies. Med Care. 2018, Feb;56(2):121-129. PMID: 29251716; PMCID: PMC5770102.DOI: 10.1097/MLR.0000000000000860.

Lepercq D, Gauss T, Godier A, et al. Association of organizational pathways with the delay of emergency surgery. JAMA Netw Open. 2023;6(4). DOI:10.1001/jamanetworkopen.2023.8145

McIsaac DI, Abdulla K, Yang H, Sundaresan S, Doering P, Vaswani SG, Thavorn K, Forster AJ. Association of delay of urgent or emergency surgery with mortality and use of health care resources: A propensity score-matched observational cohort study. CMAJ. 2017, Jul 10;189(27):E905-E912. PMID: 28694308; PMCID: PMC5505757.DOI: 10.1503/cmaj.160576.

Mahawar R, Chandak S, Yeola M. A prospective study on clinico-radiological correlation and conservative management of non-traumatic acute abdomen at a tertiary care centre. Journal of Pharmaceutical Research International. 2021;33(32B):119–124. DOI: 10.9734/jpri/2021/v33i32B31758.

Arslan, Ramazan Serdar, Doruk Barlas, Hakan Yilmaz, Suleyman Diker, Mehmet Ali Semsit. A case report of left-sided appendicitis due to midgut malrotation. Asian Journal of Case Reports in Surgery. 2021;4(1):163-67. Available:https://journalajcrs.com/index.php/AJCRS/article/view/78.

Mchele GM, Mwanga AH, Kitua DW, Chugulu S. Preoperative waiting time and outcomes of non-traumatic emergency abdominal surgeries: Insights from a zonal referral hospital in northern Tanzania, a reference for health centers with similar capacities. Surgery in Practice and Science. 2023, Sep 1;14:100202.

Peden CJ, Aggarwal G, Aitken RJ, Anderson ID, Bang Foss N, Cooper Z, Dhesi JK, French WB, Grant MC, Hammarqvist F, Hare SP, Havens JM, Holena DN, Hübner M, Kim JS, Lees NP, Ljungqvist O, Lobo DN, Mohseni S, Ordoñez CA, Quiney N, Urman RD, Wick E, Wu CL, Young-Fadok T, Scott M. Guidelines for perioperative care for emergency laparotomy enhanced recovery after surgery (ERAS) society recommendations: Part 1-preoperative: Diagnosis, rapid assessment and optimization. World J Surg. 2021,May;45(5):1272-1290. Epub 2021 Mar 6. PMID: 33677649; PMCID: PMC8026421.DOI: 10.1007/s00268-021-05994-9.

Patel MS, Thomas JJ, Aguayo X, Gutmann D, Sarwary SH, Wain M. The effect of weekend surgery on outcomes of emergency laparotomy: Experience at a highvolume district general hospital. Cureus. 2022, Mar 27;14(3):e23537. PMID: 35494929; PMCID: PMC9041642.DOI: 10.7759/cureus.23537.

Schneider C. Tyler LE, Scull EF, Pryle BJ, BarrH. A case-control study investigating factors of preoperative delay in emergency laparotomy. Int J Surg. 2015;22:131-135. DOI:10.1016/j.ijsu.2015.08.028

Cosgrove JF, GaughanM, Snowden CP, Lees T. Decreasing delays in urgent and expedited surgery in a university teaching hospital through audit and communication between peri-operative and surgical directorates. Anaesthesia. 2008;63(6):599-603. DOI:10.1111/j.1365-2044.2008.05441.x

HavensJM, Peetz AB, Do WS et al. The excess morbidity and mortality of emergency general surgery. J Trauma Acute Care Surg. 2015;78(2):306-311. DOI:10.1097/TA.0000000000000517

LeppäniemiA,JouselaI. A traffic-light coding system to organize emergency surgery across surgical disciplines. Br J Surg. 2014;101(1):e134-e140. DOI:10.1002/bjs.9325

Poulton T, Murray D; National Emergency Laparotomy Audit (NELA) project team. Pre-optimisation of patients undergoing emergency laparotomy: A review of best practice. Anaesthesia. 2019, Jan;74 Suppl 1:100-107. DOI:10.1111/anae.14514.PMID: 30604422.

Ilyas C, Jones J, Fortey S. Management of the patient presenting for emergency laparotomy. BJA Educ. 2019, Apr;19(4):113-118. DOI: 10.1016/j.bjae.2018.12.002. Epub 2019 Feb 4. PMID: 33456879; PMCID: PMC7808094.

Mullen MG, Michaels AD, Mehaffey JH, Guidry CA, Turrentine FE, Hedrick TL, Friel CM. Risk associated with complications and mortality after urgent surgery vs elective and emergency surgery: Implications for defining "quality" and reporting outcomes for urgent surgery. JAMA Surg. 2017, Aug1;152(8):768-774. PMID: 28492821; PMCID: PMC5710495.DOI: 10.1001/jamasurg.2017.0918.

Havens JM, Peetz AB, Do WS, Cooper Z, Kelly E, Askari R, Reznor G, Salim A. The excess morbidity and mortality of emergency general surgery. J Trauma Acute Care Surg. 2015,Feb;78(2): 306-11.

PMID: 25757115.DOI:10.1097/TA.0000000000000517.