title: Audit of emergent and urgent surgery for acutely ill pediatric patients: is access timely?
abstract: There is a paucity of literature about wait times for urgent/emergent surgeries in Canada. Delays and performance of non-emergent operations overnight increase morbidity and mortality. The study aim was to determine patterns of delays and performance of less-emergent surgery overnight.
  
  
  METHODS
  A retrospective analysis (June 2011-December 2013) of emergent/urgent surgeries was conducted using the ORSOS database (prospective patient and operative data). Surgeries were classified: class 1, 2A, 2B, and 3: target times of 1, 6, 24 and 72h. In hours (IH)=7:45AM-3:30PM, M-F; others were out of hours (OOH) and overnight =2300-0700.
  
  
  RESULTS
  There were 4668 operations: class 1 (5.8%), 2A (29.1%), 2B (42.1%), and 3(23%). For class 1, 2A, 2B, and 3 surgeries, mean in-room times were 2, 4.7, 15.4, and 54h respectively; 59.2% (class 1), 81.9% (class 2A), 81.2% (class 2B) and 74.4%(class 3) were performed in target. OOH occurred for 73.2% (class 1), 71.5%(class 2A), 54.7% (class 2B), and 27.7% (class 3). There were 37 class 2B and 3 surgeries overnight. There was a significant increase surgeries IH: 41.8% to 49.6%.
  
  
  CONCLUSIONS
  The majority of urgent/emergent surgery occurred OOH and the most unstable patients are least likely to have their operation within target.
  
  
  METHODS
  4.
authors.affiliation: Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. Electronic address: gschan24@alumni.ubc.ca.
authors.forename: Grace
authors.initials: G
authors.lastname: Chan
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada; Division of Pediatric Surgery, Department of Surgery, British Columbia Children's Hospital, Vancouver, BC, Canada. Electronic address: sbutterworth@cw.bc.ca.
authors.forename: Sonia A
authors.initials: SA
authors.lastname: Butterworth
mesh_terms: D002170:Canada; D002648:Child; D016208:Databases, Factual; D004630:Emergencies; D006801:Humans; D008485:Medical Audit; D010372:Pediatrics / Q000592:standards*; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000592:standards*; D013997:Time Factors; D014850:Waiting Lists
keywords: Emergency surgery; Out of hours; Surgical access