Emergency Surgery Delays Linked to Higher Death Risk

Delayed operating room access for emergency surgery increases mortality, lengthens hospital stay, and results in higher costs, claims a new study.

Researchers at Ottawa Hospital (Canada) and the University of Ottawa (Canada) conducted a study involving 15,160 patients who underwent emergency non-cardiac surgery between January 2012 and October 2014, in order to measure the impact of delay of emergency surgery on outcomes. Delay of surgery was defined as the time from surgical booking to operating room entry exceeding institutionally defined acceptable wait times, based on a standardized 5-level priority system that accounted for surgery type and indication.

The results revealed that 18.6% of patients experienced a delay, with mortality rates being 4.9% for those with delay, compared to 3.2% for those without delay, reflecting an odds ratio of 1.59. Delay was also significantly associated with increased length of stay and higher total costs. According to the researchers, the findings are consistent with evidence from other countries that delays are often due to system factors, and support the generalization of the delay-outcome association in orthopedic surgery. The study was published on July 10, 2017, in the Canadian Medical Association Journal (CMAJ).

“Delays in emergency surgeries are a problem around the world. This study adds to the evidence suggesting timely access to the operating room is important from both the patient and care provider perspectives,” concluded senior author Professor Alan Forster, MD, MSc, vice president of quality, performance, and population health at Ottawa Hospital. “To ensure emergency patients can be accommodated, it is necessary to have spare capacity. It might seem counterintuitive, but having unused time in expensive operating rooms could save both money and lives.”

“We found that most delays were due to system issues, like physician, nurse, and operating room unavailability. Improving personnel availability may improve access without increasing costs, at least from a hospital perspective,” said lead author Daniel McIsaac, MD, MPH, of Ottawa Hospital and the University of Ottawa. “Furthermore, the increased resources required to have adequate nursing personnel and physical resources should be partially offset by decreased hospital costs independently attributed to surgical delay.”

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Ottawa Hospital
University of Ottawa