If I'm not going to give pushback then I'll put an E there to reflect the surgeon's reasoning that there's urgent threat to life or body part.
I would and have laughed off 2 am hernia case. 5pm? Not so nuch. Patient is ready, surgeon is ready, I am ready and we have staff. When you are a regional center your add-ons can be 20+ in a day. No need to punt if you can do it at a reasonable time.
You manage the OR staff?
OR manager checks in w/ 1st call for every case after 5pm. We open rooms as necessary if we have the staff.
Except no pain therapy is an emergency. A spinal or even a dosed up epidural for a c-section can absolutely be an E but an epidural for the purpose of analgesia during labor is not (which is what you originally asked).
There's a higher-level question in here which really comes down to what the institutional policy is. The call anesthesiologist shouldn't be the one who has to arbitrarily decide what's urgent/emergent, what goes, what doesn't, and when.
That sounds refreshingly logical
And often the nurses. The patients NEEDS an epidural RIGHT NOW!!!
but who decides what goes on the list. do the surgeons from that department determine whats emergent. if that is the case they can try to put as much as possible on the list bc it gives them flexibility.
The departments submit a list (signed off by their respective chairs) and the periop directors (anesthesia, trauma surgery, OR nursing leadership) look over it and approve it. They'd get laughed out of the room if they tried to put lipoma removal and cataract on the list right next to incarcerated hernia and open globe, etc
This is fine except that there are plenty of cases that don’t neatly fit in the boxes.
I think most institutions can pretty easily delineate the vast, vast majority of their urgent/emergent cases if they put any effort into it. And again, at my hospital we run 1 elective OR overnight anyway so anyone with an edge case (like an appy that could probably wait til morning) can go regardless.
Institutions may say that they delineate but the reality is that the surgeons do.
They can do them the next day except that they may not be available because of something else and/or it would disrupt the surgery schedule. If they wait 24 hours any of those cases can certainly get worse.
It's been pretty well established that perioperative morbidity and mortality increases by doing cases in the middle of the night. As a surgeon, it's impossible to be meticulous and at the top of one's game at 2am. Patients deserve surgeons (and anesthesiologists) that can function at the best of their ability. If you needed a lap chole for acute cholecysitis, would you want to sit around all day until your surgeon and OR are finally ready/available at 2am? Eff no. Why don't you just bag my CBD and sign me up for a biliary drain and hepaticojejunostomy in a week or two?
Correct. The CODA studies in 2020-2021 were published in NEJM and JAMA. Surgeons are slow to change their practice from residency. Appendicitis is never a surgical emergency and can be treated with antibiotics with similar short-term and long-term outcomes.
