Introduction: In the Canadian healthcare system, limited surgical resources are typically shared between all surgical services at a given site. Consequently, it is often the case that emergency cases booked to be done within 24 hours are not actually performed within this window of time. A longer wait for such cases to be completed might increase the length of post-operative stay, and overall cost per patient. To date, this has not yet been demonstrated conclusively; if it were, it might bring with it significant budgetary implications for the Canadian healthcare system.
Methods: We undertook a retrospective cohort study of patients with age >17 booked as “E24” who underwent emergency surgery between 2008 and 2013 at University of Alberta Hospital, Edmonton, Canada. Data was obtained from combining the surgical database and the admissions database.
Linear regression analysis was performed, with the dependent variable being the time from surgery to discharge. Subgroup analysis using linear and logistic regression was also performed on neurosurgical patients, including analysis by procedure type.
Results: There were 18,926 cases performed, 11,176 (59%) of cases were male. Mean age was 52.8 years. Mean length of waiting for surgery is 1.5 days. Mean length of stay after surgery was 12.5 days.
In the neurosurgical model, there were 1,367 patients. Procedure type, surgery done on the same day of booking, ASA class, and discharge other than home without help were associated with longer stays (p<0.0001).
Conclusions: On average, patients booked for surgery within 24 hours waited longer than this window to have their procedure completed after adjusting for all confounders. The unexpected finding that surgery performed on the same day of booking may be associated with longer post-operative stay is likely explained by patient illness factors which are incompletely captured by type of discharge and ASA class data.
Patient Care: Perhaps our recommendation will contribute to health system in general and definitely that will reflect on our patients.
Learning Objectives: We have a large informative cost effective surgical database with unexpected finding which have to be addressed more closely in future work to make our recommendation.