Place to share knowledge and experience in neurosurgery and other health arena in Nepal and the whole world. We can share experience and feelings on both casual and technical neurosurgical as well as health politics, research, health economics and some literature as well.
Subhash Prasad AcharyaTribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu
Dinesh DharelTribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu
Smrity UpadhyayaTribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu
Nabin KhanalTribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu
Sandesh DahalTribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu
Sumit DahalTribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu
Karmapath AryalTribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu
Keywords: Delaying Factors, Emergency surgery, waiting times
Background: Emergency surgeries throughout the world are demanding earlier surgical times. In a developing country like Nepal this cannot be possible because of lot of factors. So we planned to study such factors that could interplay and increase the waiting time for emergency surgeries.
Methods: A prospective observational study was conducted over 45 days and all patients diagnosed with general surgical and orthopedic emergencies were followed till they were operated.
Results: Out of 1211 patients presenting to emergency department, 92 required emergency surgery. The mean age was 29.72 year and 76.1% of the patients were male. The mean time from presentation to the emergency department to the first surgical consultation was 170 minutes, from surgical consultation to decision of surgery was 28 minutes, from decision of surgery to transfer to operating room was 426 minutes, from arrival in operating room to anesthesia consultation was 18 minutes, and from anesthesia consultation to start of surgical incision was 75 minutes. The total average waiting time from arrival at emergency department to the start of surgery was 717 minutes. The factors were, viz., pre-occupancy of theatre (59.8%), special procedures/intervention required prior to surgery (23.9%), arrangement of logistics/finances by patient family (13%), arrangement of blood products (10.9%), consultations (9.8%), delay in giving consent by patients/family (5.4%), delay in arrangement of supplies (9.8%), and shift change of nursing staff (3.3%).
Conclusion: This study shows that various preventable factors increases waiting times for emergency surgeries that should be minimized so that waiting times can be reduced.
Subhash Prasad Acharya, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu
Intensivist and Clinical Coordinator, TUTH ICU
Lecturer, Department of Anaesthesiology, Institute of Medicine (IOM)
1. Lankester BJA, Britton DC, Holbrook AG, Umpleby HC, Tate JT, Budd J. Emergency surgery: atavistic refuge for the general surgeon? J Roy Soc Med 2001;94:180-2. 2. Kingham PT, Kamara TB, Cherian MN, Gosselin RA, Simkins M, Meissner MC. Quantifying Surgical Capacity in Sierra Leone. Arch Surg 2009;144:122-7. 3. Mbah N, Opara WE, Agwu NP. Waiting time among acute abdominal emergencies in a Nigerian teaching hospital: causes of delay and consequences. Nig J Surg Resch 2006;8:64-8. 4. Sampalis J, Boukas S, Liberman M, Reid T, Dupuis G. Impact of waiting time on the quality of life of patients awaiting coronary artery bypass grafting. CMAJ 2001;165:429-33. 5. Brittenden, J, Heys SD. Femoral hernia: mortality and morbidity following elective and emergency surgery. J Roy Coll Surg Edinb 1991;36:86-8. 6. Fang JF, Chen RJ, Lin BC, Hsu YB, Kao JL, Kao YC, et al. Small bowel perforation: is urgent surgery necessary? J Trauma 1999;47:515-20. 7. Aderenmu AO, Adeoti ML, Oguntola AS, Oboro VO, Fadiora SO, Akanbi OO, et al. Pattern and outcome of emergency surgery in a new Nigerian teaching hospital; The LAUTECH Oshogbo experience. Nig Postgrad Med J 2006;13:172-5. 8. Flook DJ and Crumplin MK. The efficiency of management of emergency surgery in a district general hospital - a prospective study. Ann Roy Coll Surg Engl 1990;72:27-31. 9. Eguma SA, Kalba DU. An audit of emergency anaesthesia and surgery. Nig J Surg Resch 2003;5:140-7. 10. Zue AS, Josseaume A, Nsafu DN, Galoisy-Guibal L, Carpentier JP. Surgical emergencies at Libreville hospital center. Ann Fr Anesth Reanim 2003;22:189-95. 11. Windokun A, Obideyi A. Audit of emergency theatre utilization. Afr J Med Sci 2002;31:59-62. 12. Calder FR, Jadhav V, Hale JE. The effect of a dedicated emergency theatre facility on emergency operating patterns. J R Coll Surg Edinb 1998;43:17-9. 13. P. Partelli S, Beg S, Brow J, Vyas S, Kocher HM. Alteration in emergency theatre prioritization does not alter outcome for acute appendicitis: comparative cohort study. World Journal of Emergency Surgery 2009;4:22. 14. Jawaid M, Amin MF, Khan RA, Iqbal SA. Waiting time for emergency surgeries in a tertiary care teaching hospital. Pak J Med Sci 2005;21:133-7. 15. Adamu A, Maigatari M, Lawal K, Iliyasu M. Waiting time for emergency abdominal surgery in Zaria, Nigeria. African Health Sciences 2010;10:46-53. 16. Khan AA, Furniss D, Townley WA, Jay S, West EV, Clover AJ. Prospective analysis of waiting times for emergency plastic surgery in four units. J Plast Reconstr Aesthet Surg 2011;64:873-7. 17. Sweetnam DI, Williams JR, Britton DC. An audit of the effect of a 24-hour emergency operating theatre in a district general hospital. Ann R Coll Surg Engl 1994;76(2 Suppl):56-8. 18. Wyatt MG, Houghton PW, Brodribb AJ. Theatre delay for emergency general surgical patients. Ann R Coll Surg Engl 1990;72:236-8. 19. Magee TR, Galland RB, Ramesh S, Dehn TC. Theatre delay for general surgical emergencies: a prospective audit. Ann R Coll Surg Engl 1995;77:121-4.
How to Cite
Acharya, S. P., Dharel, D., Upadhyaya, S., Khanal, N., Dahal, S., Dahal, S., & Aryal, K. (2014). Study of factors associated with waiting time for patients undergoing emergency surgery in a tertiary care centre in Nepal. Journal of Society of Anesthesiologists of Nepal, 1(1), 7-12. Retrieved from https://www.jsan.org.np/jsan/index.php/jsan/article/view/pdf_15