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[ACUTE CARE SURGERY IN ISRAEL - BURDEN OF DISEASE AND ADDITIONAL INDICATOR FOR SYSTEM DISTRESS]
Offir Ben-Ishay1,2, Yoram Kluger1,2
1Division of General Surgery, Rambam Health Care Campus, Haifa, Israel.
Introduction:
Emergency operations are indicated for trauma and general surgery emergencies. The systematic approach to the injured resulted in proven better outcomes. The management of patients presenting with acute non-traumatic emergencies did not receive the same priorities.
Aims:
The purpose of the current study is to obtain prospective data from the general surgery divisions in Israel regarding the burden of acute care surgery (ACS) and the local and national groundworks dedicated to these troublesome diseases.
Results:
A total of 25 (78.1%) of the 32 active surgical departments in Israel complied with the study. During the time frame of the study 1699 patients were admitted from the emergency departments of which 538 patients required surgical interventions. Only 16% of the hospitals in Israel have dedicated operating rooms, but 96% needed to cancel elective cases for emergency interventions during the morning hours; 51 (9.5%) elective cases were cancelled. Patients in need of emergency interventions waited 210 minutes in large hospitals (>1000 beds) significantly higher than medium (500-1000 beds) and small (<500 beds) hospitals (145 and 135 minutes respectively, p-0.006). Multivariate analysis showed that the size of the hospital (p<0.001), morning shift (p<0.001) and the diagnosis (p<0.001) were positively associated with long waiting times for surgery.
Conclusions:
The study clearly shows that a profound organizational and attitudinal change is needed in regard to emergency surgery in Israel. ACS waiting time is a good additional.
