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

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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.

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Data availability

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Code availability

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Abbreviations

ORSA:

Operating room surgical activity

OR:

Operating room

WSES:

World Society of Emergency Surgery

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Acknowledgements

The ORSA Collaborative: Ademola Adeyeye: Afe Babalola University, Nigeria; Adriana Toro: General Surgery, Augusta Hospital, Italy; adrien hodonou: Faculté de Médecine Université de Parakou, Benin; Aintzane Lizarazu: Cirugía de Urgencias, Donostia, España; Aitor Landaluce-Olavarria: Alfredo Espinosa Urduliz Hospital; Alberto Porcu: Azienda Ospedaliero Universitaria di Sassari, Italia; Aleix Martínez-Pérez: Valencian International University (VIU), SPAIN; Anastasia Pikouli: Third Department of Surgery, Attikon University Hospital; Andee Dzulkarnaen Zakaria: Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Malaysia; Andrea Barberis: S.C. Chirurgia Generale ed Epatobiliopancreatica, E.O. Ospedali Galliera. Genoa. Italy; Andrea Romanzi: Department of General Surgery, Valduce Hospital, Como, Italy; Andreas Hecker: Dept. of General & Thoracic Surgery, University Hospital of Giessen, Germany; Andrey Litvin: AI Medica LLC, Belarus ; Anna Guariniello: Ausl Romagna - Italy; ARDA ISIK: Istanbul Medeniyet University; Aristeidis Papadopoulos: General Hospital of Nikaia, Greece; Aristeidis Papadopoulos: General Hospital of Nikaia, Greece; Aristotelis Kechagias: Department of Surgery, Metropolitan General Hospital, Athens, Greece; Athanasios Marinis: Consultant Surgeon, 3rd Department of Surgery, Tzaneio General Hospital, Piraeus, Greece; Boris E. Sakakushev: Prof. Dr. Boris E. Sakakushev, MD, PhD, MHM, RIMU, Medical University Plovdiv, Department of General Surgery, First Clinic of General Surgery, UMHAT St George Plovdiv, Bulgaria; Boyko Atanasov: Medical university of Plovdiv,UMHAT Eurohospital, Bulgaria; Boyko Atanasov: Medical university of Plovdiv, UMHAT Eurohospital Bulgaria; Bruno Nardo: Annunziata Hospital, DFSN Unical, Italy; Casoni Pattacini Gianmaria: General Surgery,Emergencies and New Technologies Modena Italy; Charalampos Seretis: St Andreas General Hospital of Patras, Greece; Christos Chouliaras: MD, MSc Greece; Christos Doudakmanis: General Surgery Resident, 2nd Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Laiko General Hospital of Athens, Athens, Greece; Claudia Zaghi: General Surgery Departement San Bortolo hospital Vicenza Italy; Desire' Pantalone: Dept of Exp. Clin. Med. Careggi Hospital, Firenze, Italy; Despina Kimpizi: Hippocration General Hospital, Athens Greece; Diego Sasia: Santa Croce and Carle Hospital; Diego Visconti: AOU Città della Salute e della Scienza, Turin, Italy; Dimitrios K. Manatakis: Athens Naval and Veterans Hospital, Greece; Dimitrios Papaconstantinou: Ελλάδα; Dimitrios Schizas: First Department of Surgery, Laikon General Hospital, Athens, Greece; Edgar Fernando hernandez García: Trauma surgery chief department. Hospital central militar, méxico; Edward C.T.H. Tan: Department of Traumasurgery, Radboudumc, Nijmegen, The Netherlands; Efstratia Baili: Guys and St Thomas', London,UK; Elena Ruiz-Úcar: Consultant Bariatric and gastrointestinal Surgeon; Elif Colak: University of Samsun, Samsun and Training and Research Hospital, Turkey; Emanuel Gois Jr.: Professor of Surgery - State University of Londrina - Brazil; Emmanuel Schneck: University Hospital of Giessen, Dept. of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, Giessen, Germany; Enrico Pinotti: Policlinico San Pietro, Ponte San Pietro, Italy; Evgeni Dimitrov: Department of Surgical Diseases, University Hospital Stara Zagora, Bulgaria; Fabrizio D'Acapito: General and oncologic surgery, Morgagni-Pierantoni Hospital, Forlì, Italy; Felipe Alconchel: Virgen de la Arrixaca University Hospital (IMIB-Pascual Parrilla), Spain; Felipe Pareja: Hospital Virgen del Rocío , Spain; Francesk Mulita: Department of Surgery, General University Hospital of Patras, Greece; gabriela nita: Italia; Gennaro Martines: Azienda Ospedaliero Universitaria Policlinico Bari - Italy; Georgios Koukoulis: General Hospital of Larissa, Greece; Georgios Zacharis: Greece; Giorgio Giraudo: Department of Surgery AO Santa Croce e Carle Cuneo Italy; Giuseppe Brisinda: Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy; Giuseppe Curro': Department of Health Science, Magna Graecia University of Catanzaro, Italy; Giuseppe Palomba: Università degli studi di Napoli, Federico II; Goran Augustin: Croatia; Igor A. Kryvoruchko: Украина; Imtiaz Wani: India; Ionut Negoi: Carol Davila University of Medicine and Pharmacy Bucharest, Emergency Hospital of Bucharest, Romania; Isidoro DI CARLO: University of Catania; Justin Davies: Cambridge Colorectal Unit, Addenbrooke’s Hospital, Cambridge, UK; Kenneth Y. Y. Kok: PAP Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Brunei Darussalam; Koray Das: University of Health Sciences, Adana City and Research Hospital, General Surgery, Turkiye; Larysa Sydorchuk: Bukovinian State Medical University, Ukraine; Leandro Siragusa: University of Rome Tor Vergata; Leonardo Solaini: Department of Medical and Surgical Sciences, University of Bologna, Ospedale Morgagni Pierantoni, Forlì, Italy; Lovenish Bains: Dept of Surgery, Maulana Azad Medical College, New Delhi, India; Luca Ferrario: Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Fondazione IRCCS, Istituto Nazionale Tumori di Milano, Milan, Italy; Luis Buonomo: Argentina; Luis Buonomo: Director Emergency, Urgency and Trauma. University of Buenos Aires. Argentina.; Mahir Gachabayov: Westchester Medical Center, Valhalla, NY, USA; Mario D'Oria: University of Trieste, Italy; Mario V Papa: Hospital of Caserta; Martin Reichert: Dept. for General and Thoracic Surgery, University Hospital of Giessen, Germany; Massimiliano Veroux: University of Catania, Italy; Matthias Hecker: Deutschland; Matti Tolonen: HUS Abdominal Center, Emergency Surgery, Helsinki University Hospital and University of Helsinki, Finland; Mesina Cristian: Emergency County Hospital of Craiova, Romania; Michele Ammendola: Health of Science Department, "Magna Graecia" University Medical School, "Mater Domini" Hospital, Catanzaro, Italy; Mihail Slavchev: University Hospital Eurohospital - Plovdiv , Bulgaria; Mirko Barone: SS. Annunziata University Hospital, Chieti (Italy); Musina Ana-Maria: Universit of Medicine And Pharmacy Grigore T. Popa Iasi, Regional Institute Of Oncology Iasi, Romania; Nicola Cillara: UOC Chirurgia Generale PO Santissima Trinità ASL Cagliari; Nicolò Tamini: Asst Monza - Ospedale San Gerardo; Nikolaos Machairas: 2nd Department of Propaedeutic Surgery, Laiko University Hospital, Athens, Greece; Nikolaos Pararas: Third Surgical Department, National and Kapodistrian University of Athens, Greece; Orestis Ioannidis: 4th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece; Osvaldo Chiara: General Surgery and Trauma Team Universita' degli Studi di Milano-ASST Niguarda; Pietro Bisagni: ASST Lodi Italy; Raluca Bievel Radulescu: Banca degli Occhi, Italy; Roberto Bini: AAST Niguarda Hospital, Milan, Italy; Ruslan Sydorchuk: Regional Emergency Hospital Chernivtsi, Ukraine; Selmy Awad: Department of General Surgery,Mansoura university hospitals,Egypt; Semra Demirli Atici: Izmir Cigli Kent Hospital, Department of General Surgery; Sharfuddin Chowdhury: King Saud Medical City, Riyadh, Saudi Arabia; Silvia Severi: Ospedale Del Delta - Lagosanto (FE) Italy; Somprakas Basu: Professor of Surgery, All India Institute of Medical Sciences, Rishikesh, India; Stefano Olmi: Head of General and Oncologic Surgery Center for Minimal Invasive and Laparoscopic Surgery Bariatric Center of Excellence SICOB. Policlinico San Marco, Zingonia; Stefano Piero Bernardo Cioffi: Acute care and trauma surgery, Niguarda hospital, Milan, Italy; Tapan Patel: Baroda Medical College and SSG Hospital, India; Teresa Perra: Azienda Ospedaliero Universitaria di Sassari, Italia; Timothy Craig Hardcastle: South Africa; Vasilescu Alin Mihai: Department of Surgery, Grigore T. Popa University of Medicine and Pharmacy Iasi, St Spiridon University Hospital Iasi, Romania; Victor Kong: University of KwaZulu Natal, Durban, South Africa; Vishal Shelat: Singapore; Vladimir Khokha: Mozyr City Hospital, head surgeon. Belarus; Wagih Ghannam: Mansoura faculty of medicine,trauma and emergency surgery unit Egypt; Yunfeng Cui: Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China.

Funding

Not applicable.

Author information

Authors and Affiliations

  1. Department of Emergency and Trauma Surgery, Villeneuve St Georges Academic Hospital, Villeneuve St Georges, France

    Belinda De Simone

  2. Department of General and Emergency surgery, Level I Trauma Center, Bufalini Hospital, Cesena, Italy

    Vanni Agnoletti & Fausto Catena

  3. The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates

    Fikri M. Abu-Zidan

  4. Department of Emergency and Trauma Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA

    Walter L. Biffl

  5. Ernest E. Moore Shock Trauma Center, University of Colorado, Denver, USA

    Ernest E. Moore

  6. Unit of Metabolic and General Surgery, Clinique St Louis, Poissy, France

    Elie Chouillard

  7. Department of General and Trauma Surgery, University Hospital of Pisa, Pisa, Italy

    Federico Coccolini

  8. Department of General Surgery, Macerata Hospital, Macerata, Italy

    Massimo Sartelli

  9. Department of General Surgery, University Hospital of Cagliari, Cagliari, Italy

    Mauro Podda

  10. Department of General Surgery, Santa Maria del Soccorso Hospital, San Benedetto del Tronto, Ascoli Piceno, Italy

    Salomone Di Saverio

  11. Department of Emergency and Trauma Surgery, Harvard Medical School & Massachusetts General Hospital, Boston, USA

    Haytham Kaafarani

  12. Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia

    Zsolt J. Balogh

  13. Acute Care Surgery and Trauma Unit, Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem Kiriat Hadassah, Jerusalem, Israel

    Miklosh Bala

  14. Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland

    Ari K. Leppäniemi

  15. General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, AB, Canada

    Andrew W. Kirkpatrick

  16. Medical School, National and Kapodistrian University of Athens, (NKUA), Athens, Greece

    Emmanouil Pikoulis

  17. Department of Surgery, Anadolu Medical Center, Kocaali, Turkey

    Kemal Rasa

  18. Department of Emergency and General Surgery, Level I Trauma Center, Bufalini Hospital, Cesena, Italy

    Chiara Rosato

  19. General Surgery Department, Western Michigan University, Kalamazoo, MI, USA

    Robert Sawyer

  20. Department of General Surgery, University Hospital of Pavia, Pavia, Italy

    Luca Ansaloni

  21. Colorectal and Digestive Surgery Unit, DIGEST Department Beaujon University Hospital (AP-HP), University Paris Cité, Paris, France

    Nicola de’Angelis

  22. Department of General Surgery, Royal Infirmary Edinburgh, Edinburgh, UK

    Dimitris Damaskos

  23. Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, 27834, USA

    Philip F. Stahel

  24. Division of General Surgery, Rambam Health Care Campus, Haifa, Israel

    Yoram Kluger

  25. Riverside University Health System Medical Center and Loma Linda University School of Medicine, Loma Linda, USA

    Raul Coimbra

  26. eCampus University, CREAS, Ser.In.Ar. Bologna University, Bologna, Italy

    Fausto Catena

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

The ORSA Collaborative

  • Ademola Adeyeye
  • , Adriana Toro
  • , adrien Hodonou
  • , Aintzane Lizarazu
  • , Aitor Landaluce-Olavarria
  • , Alberto Porcu
  • , Aleix Martínez-Pérez
  • , Anastasia Pikouli
  • , Andee Dzulkarnaen Zakaria
  • , Andrea Barberis
  • , Andrea Romanzi
  • , Andreas Hecker
  • , Andrey Litvin
  • , Anna Guariniello
  • , Arda Isik
  • , Aristeidis Papadopoulos
  • , Aristeidis Papadopoulos
  • , Aristotelis Kechagias
  • , Athanasios Marinis
  • , Boris E. Sakakushev
  • , Boyko Atanasov
  • , Boyko Atanasov
  • , Bruno Nardo
  • , Casoni Pattacini Gianmaria
  • , Charalampos Seretis
  • , Christos Chouliaras
  • , Christos Doudakmanis
  • , Claudia Zaghi
  • , Desire’ Pantalone
  • , Despina Kimpizi
  • , Diego Sasia
  • , Diego Visconti
  • , Dimitrios K Manatakis
  • , Dimitrios Papaconstantinou
  • , Dimitrios Schizas
  • , Edgar Fernando hernandez García
  • , Edward C. T. H. Tan
  • , Efstratia Baili
  • , Elena Ruiz-Úcar
  • , Elif Colak
  • , Emanuel Gois Jr.
  • , Emmanuel Schneck
  • , Enrico Pinotti
  • , Evgeni Dimitrov
  • , Fabrizio D’Acapito
  • , Felipe Alconchel
  • , Felipe Pareja
  • , Francesk Mulita
  • , Gabriela Nita
  • , Gennaro Martines
  • , Georgios Koukoulis
  • , Georgios Zacharis
  • , Giorgio Giraudo
  • , Giuseppe Brisinda
  • , Giuseppe Curro’
  • , Giuseppe Palomba
  • , Goran Augustin
  • , Igor A Kryvoruchko
  • , Imtiaz Wani
  • , Ionut Negoi
  • , Isidoro Di Carlo
  • , Justin Davies
  • , Kenneth Y. Y. Kok
  • , Koray Das
  • , Larysa Sydorchuk
  • , Leandro Siragusa
  • , Leonardo Solaini
  • , Lovenish Bains
  • , Luca Ferrario
  • , Luis Buonomo
  • , Luis Buonomo
  • , Mahir Gachabayov
  • , Mario D’Oria
  • , Mario V Papa
  • , Martin Reichert
  • , Massimiliano Veroux
  • , Matthias Hecker
  • , Matti Tolonen
  • , Mesina Cristian
  • , Michele Ammendola
  • , Mihail Slavchev
  • , Mirko Barone
  • , Musina Ana-Maria
  • , Nicola Cillara
  • , Nicolò Tamini
  • , Nikolaos Machairas
  • , Nikolaos Pararas
  • , Orestis Ioannidis
  • , Osvaldo Chiara
  • , Pietro Bisagni
  • , Raluca Bievel Radulescu
  • , Roberto Bini
  • , Ruslan Sydorchuk
  • , Selmy Awad
  • , Semra Demirli Atici
  • , Sharfuddin Chowdhury
  • , Silvia Severi
  • , Somprakas Basu
  • , Stefano Olmi
  • , Stefano Piero Bernardo Cioffi
  • , Tapan Patel
  • , Teresa Perra
  • , Timothy Craig Hardcastle
  • , Vasilescu Alin Mihai
  • , Victor Kong
  • , Vishal Shelat
  • , Vladimir Khokha
  • , Wagih Ghannam
  •  & Yunfeng Cui

Contributions

FC and VA conceived the research project; BDS designed the survey, collected, analyzed the data, reviewed the literature and wrote the draft. FC revised the first draft. All the authors read and approved the final draft.

Corresponding author

Correspondence to Belinda De Simone.

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Conflict of interest

The authors have no conflict of interest with this study.

Ethical approval

This study reports the anonymous results of an international survey and it does not require ethical approval.

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The members of “The ORSA Collaborative” are given in Acknowledgements.

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De Simone, B., Agnoletti, V., Abu-Zidan, F.M. et al. The Operating Room management for emergency Surgical Activity (ORSA) study: a WSES international survey. Updates Surg 76, 687–698 (2024). https://doi.org/10.1007/s13304-023-01668-4

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