Mortality rates among emergency general surgery patients increase the longer patients are forced to wait for surgery after hospital arrival, according to a study presented at the 2024 annual meeting of the Eastern Association for the Surgery of Trauma.

“Knowing the current challenges of limited resources and often multiple patients requiring emergent surgery, triaging patients can be challenging,” said lead author David Silver, MD, a general surgery resident at UPMC, in Pittsburgh. “There is literature regarding the timing of specific pathologies, but no overarching protocol or scheme is widely used for triage.”

To address this gap, Dr. Silver and his colleagues sought to determine whether time from first contact to operation start is associated with mortality among emergency general surgery (EGS) patients.

They conducted a retrospective cohort study using an EGS registry at four hospitals, focused on adults who underwent operative intervention for a primary American Association for the Surgery of Trauma–defined EGS diagnosis between 2021 and 2023. People who underwent surgery more than 72 hours after hospital admission were considered nonurgent and excluded. The exposure of interest was defined as the time from the first vital sign capture to skin incision time stamp.

For the total 1,199 patients, the median time to OR was 490 minutes. The relative likelihood of in-hospital mortality increased with prolonged time to OR, with the highest odds of mortality for those who had their operation between 400 and 641 minutes after their vitals were first recorded.

“The study’s key findings highlight the critical significance of timely intervention in emergency surgery cases,” Dr. Silver said. “The research identifies specific patient groups, such as those with signs of end-organ damage, prolonged transport times and frailty, as particularly vulnerable to adverse outcomes with delayed surgical procedures.”

He added that “what is also novel is that this study uses a newly developed EGS registry from a large healthcare system for the new EGS verification program, offering a system-level and granular patient perspective, and examines timing from patient’s initial contact with the healthcare system to the initiation of surgery. This comprehensive approach provides valuable insights that can inform improved management strategies for EGS patients, emphasizing the importance of timely intervention and the influence of specific patient characteristics on outcomes.”

Dr. Silver noted that future research areas exist, including pinpointing specific patient populations and diseases that are most sensitive to delays to operation, identifying systemic opportunities for improving intervention times and integrating study results into broader contexts to enhance triage protocols across surgical emergencies.