{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T08:39:16Z","timestamp":1787819956434,"version":"build-2784847793"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T00:00:00Z","timestamp":1746576000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T00:00:00Z","timestamp":1746576000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"University of Bern"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Langenbecks Arch Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Emergency general abdominal surgery (EGS) is associated with high morbidity and mortality. Timely intervention and effective triage systems are crucial to improve outcomes. This study evaluates the impact of surgeons\u2019 prioritization and adherence to a triage protocol on postoperative outcomes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Single-center retrospective analysis of patients undergoing EGS at Bern University Hospital from 03\/2015\u201312\/2022. Patients were categorized into four triage levels based on the urgency of surgery (level 1 within 1\u00a0h, level 2 within 6\u00a0h, level 3 within 12\u00a0h, and level 4 within 24\u00a0h). \u201cProtocol violation\u201d was defined in cases where the delay to surgery exceeded the triage level. Primary endpoint included complications according to Clavien-Dindo classification in patients with versus without \u201cprotocol violation\u201d.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>A total of 1\u2032947 patients were included. The mean overall delay from admission to surgery was in triage level 1 69.5\u2009\u00b1\u2009127.5\u00a0min., in triage level 2 206.5\u2009\u00b1\u2009178.0\u00a0min., in triage level 3 350.6\u2009\u00b1\u2009282.6\u00a0min. and in triage level 4 693.4\u2009\u00b1\u2009354.8\u00a0min.. Triage levels 1 and 2 correlated significantly with increased complication rates compared to triage level 3 and 4 (64% vs. 43% vs. 11% vs. 10%, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009<jats:italic>0.001<\/jats:italic>). Similarly, mortality rates decreased significantly from triage level 1 through 4 (26% vs. 7% vs. 1% vs. 2%, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009<jats:italic>0.001<\/jats:italic>). \u201cProtocol violation\u201d occurred in a total of 13% of patients with decreasing proportions from triage level 1 to 4 (37% vs. 13% vs. 12% vs. 0%, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009<jats:italic>0.001<\/jats:italic>). \u201cProtocol violation\u201d did not statistically affect overall morbidity and mortality in most of the diagnoses. In patients with intestinal ischemia or abdominal abscesses, mortality was significantly higher in patients with \u201cprotocol violation\u201d. In contrast, in patients suffering from acute inguinal hernias or gastrointestinal bleeding, morbidity was significantly higher in patients without \u201cprotocol violation\u201d. A significantly shorter hospital length of stay (HLOS) was shown in triage level 2 and triage level 3 when patients were treated without \u201cprotocol violation\u201d (8.6\u2009\u00b1\u200910.0\u00a0days vs. 13.5\u2009\u00b1\u200917.3\u00a0days, <jats:italic>p<\/jats:italic>\u2009=\u20090.022 and 5.3\u2009\u00b1\u20098.7\u00a0days vs. 6.4\u2009\u00b1\u20096.7\u00a0days, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001, respectively).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Surgeons\u2019 triage levels significantly correlated with mortality and morbidity. Moreover, \u201cprotocol violation\u201d resulted in higher mortality in patients suffering from mesenteric ischemia and abdominal abscesses and resulted in prolonged HLOS. Further incorporating objective parameters into triage decisions in the EGS population may enhance prioritization accuracy, patient safety and resource utilization.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00423-025-03723-7","type":"journal-article","created":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T07:33:46Z","timestamp":1746603226000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Surgeons\u2019 prioritization of emergency abdominal surgery and its impact on postoperative outcomes"],"prefix":"10.1007","volume":"410","author":[{"given":"Severin","family":"Gloor","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Wyss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Candinas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beat","family":"Schn\u00fcriger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,7]]},"reference":[{"key":"3723_CR1","unstructured":"Europastatistik. 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