Surgical Emergency Flows and Delays in Admission to the Operating Room (ACUTE-FLOW)

Flows of Emergency Surgery and Delay in Admission to the Operating Room: a Multicenter Prospective Observational Study in France

French hospitals treat non-elective surgery according to three organizational models: in a dedicated multi-specialty emergency operative room (OR), in a dedicated OR within a specialized surgical platform or in any available OR from a list of non-dedicated OR. Some triage algorithms for the classification of non-elective surgery have been described but are not routinely applied. The rate of delay in the management of non-elective surgery in France is not known. Reducing this delay decreased mortality and morbidity in urgent surgery (McIsaac D, et al., CMAJ 2017). Optimizing the flow of non-elective surgery represents a major challenge. The main objective of this study is to determine the rate of delay in admission to the OR in emergency surgery through a multicenter prospective observational study in France. All patients requiring urgent surgical management (<72 hours) will be included. The ideal time for surgery was previously defined by surgeons according to the NEST classification (NEST 1: within minutes; NEST 2: < 1 hour; NEST 3: < 4 hours; NEST 4: < 12 hours; NEST 5: < 48 hours; NEST 6: < 72 hours). For each patient, the ratio between the observed time (actual Time To Surgery [aTTS] ) and the ideal time (ideal Time To Surgery [iTTS]) will be determined. The delay is identified by aTTS/iTTS ratio >1.

Study Overview

• Status: Completed
• Conditions: Postoperative Complications; Emergencies; Surgery

• Study Type: Observational
• Enrollment (Actual): 1149

Contacts and Locations

Study Locations

• France
  • Angers, France
    • University Hospital
  • Antony, France
    • Clinique
  • Clichy, France
    • Beaujon Hospital
  • Créteil, France
    • Henri Mondor Hospital
  • Grenoble, France
    • University Hospital
  • Lille, France
    • University Hospital
  • Lyon, France
    • Edouard Herriot Hospital
  • Lyon, France
    • Hopital Sud
  • Paris, France
    • HEGP
  • Strasbourg, France
    • University Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Patients aged at least 18 years hospitalized and requiring non-elective surgery.

Non-elective means that the surgery must ideally be performed within 72 hours. Patients may be coming in via the emergency department or may already be hospitalized when requiring surgical intervention.

Anthony).

Description

Inclusion Criteria:

any patient meeting the Following two criteria

• at least 18 ys old
• decision for unplanned surgery (which should be performed within 72 hours according to the protocol)
• in one of the following hospitals: Lille University hospital, Grenoble University hospital, Strasbourg University hospital, Paris University hospitals (Européen Georges Pompidou, Beaujon, H. Mondor), Lyon University hospital (Hôpital E. Herriot, Lyon Sud), Angers University hospital, Anthony Private hospital).

Exclusion Criteria:

• obstetrics
• interventional radiology
• endoscopies

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incidence of OR admission delay (delay = aTTS / iTTS > 1)	hours	30 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
OR Admission delay according to the three organizational model	hours	30 days
OR Admission delay according to the period of work (day, night, and week-end)	hours	30 days
OR Admission delay according to the NEST classification	hours	30 days
delays related to organisational causes	hours	30 days
delays related to material causes	hours	30 days
delays related to human causes	hours	30 days
Impact of the delay on ICU length of stay	days	30 days
Impact of the delay on hospital length of stay	days	30 days
Impact of the delay on mortality		30 days
Impact of the delay on morbidity		30 days

Collaborators and Investigators

• Sponsor: University Hospital, Lille
• Collaborators: Société Française d'Anesthésie et de Réanimation
• Investigators: Principal Investigator: Delphine GARRIGUE, MD, University Hospital, Lille, France; Study Chair: Benoit TAVERNIER, MD, PhD, University Hospital, Lille, France

Study record dates

Study Major Dates

• Study Start (ACTUAL): October 5, 2020
• Primary Completion (ACTUAL): March 15, 2021
• Study Completion (ACTUAL): March 15, 2021

Study Registration Dates

• First Submitted: October 5, 2020
• First Submitted That Met QC Criteria: October 12, 2020
• First Posted (ACTUAL): October 14, 2020

Study Record Updates

• Last Update Posted (ACTUAL): May 26, 2021
• Last Update Submitted That Met QC Criteria: May 25, 2021
• Last Verified: May 1, 2021

More Information

Terms related to this study

• Keywords: delay; organization
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies; Postoperative Complications
• Other Study ID Numbers: NI2020/01

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No