Hospital capacity and operating room access for emergency general surgery patients : OR access and LOS for short-stay...

Emergency general surgery (EGS) is a major driver of hospital utilization, yet system-level contributors to hospital length of stay (LOS) remain poorly defined. While delayed operative intervention may be clinically acceptable in stable patients, its impact on hospital throughput is unclear. We evaluated the association between time to operating room (OR) and LOS for common minimally invasive (MIS) EGS procedures.

We performed a retrospective cohort study of adult patients undergoing non-elective MIS appendectomy or cholecystectomy on a dedicated EGS service at two community hospitals (2023-2025) using EGS-targeted NSQIP data. Time-to-OR was defined as the interval from emergency department registration to procedure start. LOS was defined as admission to discharge (LOS=0 for outpatient cases). A two-part hurdle model assessed association between time-to-OR and LOS, and multivariable logistic regression evaluated the associations between time-to-OR and 30-day readmission and 30-day emergency department (ED) visits.

Among 1355 patients, median time-to-OR was 16 h (IQR 8-30); 38% underwent surgery ≤12 h and 67% within 24 h. Median LOS was 0 days. Mean LOS increased from 0.68 days among patients undergoing surgery ≤12 h to 4.62 days with delays ≥48 h (p<0.001). Adjusted hurdle models indicated that increasing time to surgery was associated with higher likelihood of inpatient admission. Among admitted patients, surgery delayed ≥48 h were associated with longer expected LOS than other categories, with an adjusted mean LOS of 6.19 days (95% CI 4.94-7.44) compared with 3.43-3.78 days for shorter delays. No association was identified between time-to-OR and 30-day readmission or 30-day ED visits.

For MIS appendectomy and cholecystectomy, longer time-to-OR was independently associated with increased LOS. The increase in LOS was concentrated in the preoperative interval; postoperative LOS did not lengthen with preoperative delay. OR access represents a modifiable, system-level target for improving hospital capacity.