New classification system to improve scheduling of emergency surgery highlighted in BJS issue

December 16, 2013

Researchers in Finland have implemented a classification system for emergency operations that allows for a fair and efficient way to manage a large volume of such surgery. The system is described in a special issue of the BJS (British Journal of Surgery) that focuses on emergency surgery. Other studies in the issue focus on topics ranging from advances in the use of surgery performed through natural orifices to the global burden of conditions requiring emergency surgery.

Among hospitals, there is growing interest in centralizing emergency surgery into specialized centres that have sufficient resources and available expertise to improve patient care and save more lives. Increasing the volume of emergency operations in such regional centres -- which also perform elective, or planned, surgery -- requires new structural and organizational elements that allow patients needing emergency surgery to be operated on without unnecessary delay, but also ensure that elective operations are not negatively affected.

Ari Leppäniemi, MD, PhD, and Irma Jousela, MD, PhD, of the University of Helsinki, in Finland, now describe a system that has been in use at their hospital for several years that addresses these issues. The system introduces elements such as having a significant number of operating tables designated specifically for emergency surgery during the daytime. Also, because not all emergency operations need to be done immediately but can be safely postponed until the next day, only operations that are truly urgent can be performed in the evenings and a nighttime. A colour-coding system categorizes emergency operations by urgency and helps to optimize the timing of emergency operations in a rational and fair way. The computerized system also enables the investigators to monitor how effective their system is and whether there are systematic errors or problems that need to be solved.

"Our study documents some of the objectively measurable benefits of the system. For example, the proportion of nighttime emergency operations has clearly decreased without causing disturbances in elective surgery or delaying surgery for those patients who need it urgently--the red code patients," explained Dr Leppäniemi. Another benefit of the system was demonstrated in the improved efficiency of operating room use during the day.

In another article published in the BJS's special issue, investigators reviewed the history and effectiveness of surgery performed through natural orifices -- called natural orifice transluminal endoscopic surgery, or NOTES -- revealing that selected techniques offer reduced invasiveness for patients with intra-abdominal emergencies and may improve outcomes. "Steady future development and adoption of NOTES are likely to follow as technology improves and surgeons become comfortable with the approaches," they wrote.

Also in the special issue is a review of the global burden of conditions requiring emergency surgery (excluding trauma and obstetrics). The researchers found that in 2010, there were 896,000 deaths, 20 million years of life lost, and 25 million disability-adjusted life-years from 11 emergency general surgical conditions. The most common cause of death was complicated peptic ulcer disease, followed by aortic aneurysm, bowel obstruction, biliary disease, mesenteric ischemia, peripheral vascular disease, abscess and soft tissue infections, and appendicitis. The majority of deaths occurred in low- and middle-income countries, which have inadequate capacity to deal with the problem. "The data presented in this study will be useful for both the surgical and public health communities to plan a more adequate response," the authors wrote.
-end-


Wiley

Related Surgery Articles from Brightsurf:

Decision conflict before cancer surgery correlates with lower activity after surgery
Nearly one-third of cancer patients who decide to undergo surgery for their condition may have second thoughts, and this decision conflict may lead to less favorable treatment outcomes in both the near- and long-term, according to a team of investigators at Massachusetts General Hospital and Ariadne Labs.

Examining association between weight loss before bariatric surgery, risk of death after surgery
Researchers looked at whether a patient's body weight and weight loss before bariatric surgery were associated with risk of death within 30 days after surgery using data from nearly 500,000 patients in the US and Canada.

Guidelines for thyroid surgery published in Annals of Surgery
The first set of comprehensive, evidence-based clinical guidelines for surgical treatment of thyroid disease -- developed by an expert panel assembled by the American Association of Endocrine Surgeons (AAES) -- was published today by Annals of Surgery.

Colorectal surgery patients use fewer opioids, report less pain with enhanced recovery after surgery
Colorectal surgery patients who were a part of an enhanced recovery after surgery (ERAS) program had less pain, while using nearly half as many opioids, according to research being presented at the ANESTHESIOLOGY® 2019 annual meeting.

Video assisted lung surgery reduces complications and hospital stays compared to open surgery
Video-assisted thoracic surgery is associated with lower in-hospital complications and shorter length of stay compared with open surgery among British patients who were diagnosed at an early stage of lung cancer, according to research presented today the IASLC 2019 World Conference on Lung Cancer, hosted by the International Association for the Study of Lung Cancer.

Most deaths related to noncardiac surgery occur after surgery and after discharge from hospital
It's not the operating room that is risky for patients undergoing noncardiac surgery; it's the recovery period.

Study looks at opioid use after knee surgery
A small study looked at whether reducing the number of opioid tablets prescribed after knee surgery would reduce postoperative use and if preoperative opioid-use education would reduce it even more.

Surgery patients are getting older every year
A new BJS (British Journal of Surgery) analysis reveals that people undergoing surgery in England are getting older at a faster rate than the general population.

Children requiring thyroid surgery have better outcomes at high-volume surgery centers
New research recently published in the Journal of Pediatric Surgery found that post-operative success rates of pediatric thyroid patients, particularly children who require a thyroidectomy, correlate with the institution's patient volume.

Do negative public attitudes toward weight loss surgery stop some patients from having surgery?
Most patients who qualify for weight loss surgery don't have the procedure despite its safety and effectiveness.

Read More: Surgery News and Surgery Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.