{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:17:51Z","timestamp":1792783071562,"version":"4.5.0"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"University of Melbourne","id":[{"id":"https:\/\/ror.org\/01ej9dk98","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Health Care Manag Sci"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Balancing elective and emergency surgeries in operating room (OR) scheduling is challenging due to uncertainty in surgery durations and emergency arrivals. Traditional approaches, such as dedicated OR allocation and the Break-in-Moment (BIM) policy, can result in underutilised capacity and high emergency cancellation rates. This paper proposes a two-stage stochastic optimisation model that incorporates endogenous buffer allocation within the OR schedule. Rather than relying on policy-based or heuristically defined buffer times, the proposed framework determines the timing and placement of buffer slots as part of the optimisation process. In the first stage, elective surgeries and buffer placements are jointly determined at the beginning of the week. In the second stage, OR allocations are adjusted in response to realised emergency arrivals and surgery-duration deviations. The model is solved using the Sample Average Approximation (SAA) method and benchmarked against deterministic, perfect-information, and robust optimisation approaches. We validate the model using a synthetic dataset calibrated to real OR data from a public hospital. Computational experiments show that the proposed endogenous buffer-allocation approach achieves significant cost and cancellation reductions compared with all benchmark methods, while closely approaching the idealised perfect-information solution. Results over a six-month period indicate an 18% reduction in total weekly costs, an increase in average OR utilisation from 78% to 84%, and a substantial decrease in emergency cancellations. These findings demonstrate the value of endogenous buffer allocation for improving OR efficiency and responsiveness under uncertainty.<\/jats:p>","DOI":"10.1007\/s10729-026-09791-5","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T07:30:47Z","timestamp":1789025447000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Operating-Room scheduling under uncertainty: balancing elective and emergency surgeries"],"prefix":"10.1007","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2371-1222","authenticated-orcid":false,"given":"Hajar","family":"Sadegh Zadeh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lele","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Fackrell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamideh","family":"Anjomshoa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"key":"9791_CR1","unstructured":"Calder R, Dunkin R, Rochford C, Nichols T (2019) Australian health services: too complex to navigate. A review of the national reviews of Australia\u2019s health service arrangements. Australian Health Policy Collaboration, Policy Issues Paper No. 1"},{"key":"9791_CR2","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1007\/s10878-018-0322-6","volume":"37","author":"S Zhu","year":"2019","unstructured":"Zhu S, Fan W (2019) Yang: Operating room planning and surgical case scheduling: a review of literature. J Comb Optim 37:757\u2013805","journal-title":"J Comb Optim"},{"key":"9791_CR3","doi-asserted-by":"publisher","unstructured":"Vandenberghe M, De Vuyst S, Aghezzaf E-H, Bruneel H (2021) Stochastic surgery selection and sequencing under dynamic emergency break-ins. Journal of the Operational Research Society 72(6):1309\u20131329. https:\/\/doi.org\/10.1080\/01605682.2020.1715477","DOI":"10.1080\/01605682.2020.1715477"},{"issue":"1","key":"9791_CR4","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/j.ejor.2016.11.043","volume":"260","author":"S Neyshabouri","year":"2017","unstructured":"Neyshabouri S, Berg BP (2017) Two-stage robust optimization approach to elective surgery and downstream capacity planning. Eur J Oper Res 260(1):21\u201340","journal-title":"Eur J Oper Res"},{"issue":"1\u20132","key":"9791_CR5","first-page":"68","volume":"30","author":"J Koppka","year":"2018","unstructured":"Koppka J, Oliveira F, Tanfani E, Testi A (2018) Operating room planning and scheduling: A literature review. Flex Serv Manuf J 30(1\u20132):68\u2013102","journal-title":"Flex Serv Manuf J"},{"key":"9791_CR6","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/j.orhc.2018.03.006","volume":"19","author":"LR Kroer","year":"2018","unstructured":"Kroer LR, Foverskov K, Vilhelmsen C, Hansen AS, Larsen J (2018) Planning and scheduling operating rooms for elective and emergency surgeries with uncertain duration. Operations Research for Health Care 19:107\u2013119. https:\/\/doi.org\/10.1016\/j.orhc.2018.03.006","journal-title":"Operations Research for Health Care"},{"key":"9791_CR7","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1016\/j.cie.2016.05.016","volume":"97","author":"G Latorre-N\u00fa\u00f1ez","year":"2016","unstructured":"Latorre-N\u00fa\u00f1ez G, L\u00fcer-Villagra A, Marianov V, Obreque C, Ramis F, Neriz L (2016) Scheduling operating rooms with consideration of all resources, post anesthesia beds and emergency surgeries. Computers & Industrial Engineering 97:248\u2013257","journal-title":"Computers & Industrial Engineering"},{"key":"9791_CR8","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1016\/j.cie.2014.11.021","volume":"80","author":"H Saadouli","year":"2015","unstructured":"Saadouli H, Jerbi B, Dammak A, Masmoudi L, Bouaziz A (2015) A stochastic optimization and simulation approach for scheduling operating rooms and recovery beds in an orthopedic surgery department. Computers & Industrial Engineering 80:72\u201379","journal-title":"Computers & Industrial Engineering"},{"issue":"2","key":"9791_CR9","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1016\/j.ijpe.2009.03.009","volume":"119","author":"B Cardoen","year":"2009","unstructured":"Cardoen B, Demeulemeester E, Beli\u00ebn J (2009) Optimizing a multiple objective surgical case sequencing problem. Int J Prod Econ 119(2):354\u2013366","journal-title":"Int J Prod Econ"},{"key":"9791_CR10","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/j.cor.2016.04.017","volume":"74","author":"G Xiao","year":"2016","unstructured":"Xiao G, Jaarsveld W, Dong M, Van De Klundert J (2016) Stochastic programming analysis and solutions to schedule overcrowded operating rooms in china. Computers & Operations Research 74:78\u201391. https:\/\/doi.org\/10.1016\/j.cor.2016.04.017","journal-title":"Computers & Operations Research"},{"issue":"1","key":"9791_CR11","first-page":"232","volume":"98","author":"DP Strum","year":"2003","unstructured":"Strum DP, May JH, Sampson AR, Vargas LG, Spangler WE (2003) Estimating times of surgeries with two component procedures: Comparison of the lognormal and normal models. Anesthesiology The Journal of the American Society of Anesthesiologists 98(1):232\u2013240","journal-title":"Anesthesiology The Journal of the American Society of Anesthesiologists"},{"issue":"3","key":"9791_CR12","doi-asserted-by":"publisher","first-page":"642","DOI":"10.1016\/j.ejor.2010.03.014","volume":"206","author":"D Min","year":"2010","unstructured":"Min D, Yih Y (2010) Scheduling elective surgery under uncertainty and downstream capacity constraints. Eur J Oper Res 206(3):642\u2013652","journal-title":"Eur J Oper Res"},{"issue":"11","key":"9791_CR13","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1007\/s12630-010-9371-8","volume":"57","author":"R Alvarez","year":"2010","unstructured":"Alvarez R, Bowry R, Carter MW (2010) Prediction of the time to complete a series of surgical cases to avoid cardiac operating room overutilization. Can J Anesth 57(11):973\u2013979. https:\/\/doi.org\/10.1007\/s12630-010-9371-8. (Epub 2010 Aug 20 PMID: 20725818)","journal-title":"Can J Anesth"},{"key":"9791_CR14","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1016\/j.orhc.2015.05.005","volume":"7","author":"CV Riet","year":"2015","unstructured":"Riet CV, Demeulemeester E (2015) Trade-offs in operating room planning for electives and emergencies: A review. Operations Research for Health Care 7:52\u201369","journal-title":"Operations Research for Health Care"},{"issue":"1","key":"9791_CR15","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1287\/mnsc.1070.0756","volume":"54","author":"M Olivares","year":"2008","unstructured":"Olivares M, Terwiesch C, Cassorla L (2008) Structural estimation of the newsvendor model: An application to reserving operating room time. Manage Sci 54(1):41\u201355","journal-title":"Manage Sci"},{"issue":"4","key":"9791_CR16","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1007\/s10732-010-9139-x","volume":"17","author":"A Riise","year":"2011","unstructured":"Riise A, Burke EK (2011) Local search for the surgery admission planning problem. Journal of Heuristics 17(4):389\u2013414","journal-title":"Journal of Heuristics"},{"key":"9791_CR17","doi-asserted-by":"crossref","unstructured":"Rachuba S, Werners B (2017) A fuzzy multi-criteria approach for robust operating room schedules. Ann Oper Res 251(1\u20132):325\u2013350","DOI":"10.1007\/s10479-015-1926-1"},{"issue":"24","key":"9791_CR18","doi-asserted-by":"publisher","first-page":"7252","DOI":"10.1080\/00207543.2015.1033500","volume":"53","author":"A Jebali","year":"2015","unstructured":"Jebali A, Diabat A (2015) A stochastic model for operating room planning under capacity constraints. Int J Prod Res 53(24):7252\u20137270","journal-title":"Int J Prod Res"},{"issue":"7","key":"9791_CR19","doi-asserted-by":"publisher","first-page":"1584","DOI":"10.1287\/mnsc.2014.2067","volume":"61","author":"VA Truong","year":"2015","unstructured":"Truong VA (2015) Optimal advance scheduling. Manage Sci 61(7):1584\u20131597","journal-title":"Manage Sci"},{"key":"9791_CR20","doi-asserted-by":"crossref","unstructured":"Jonnalagadda R, Walrond E, Hariharan S, Walrond M, Prasad C (2005) Evaluation of the reasons for cancellations and delays of surgical procedures in a developing country. Int J Clin Pract 59(6):716\u2013720","DOI":"10.1111\/j.1742-1241.2004.00354.x"},{"key":"9791_CR21","doi-asserted-by":"crossref","unstructured":"Utzolino S, Kaffarnik M, Keck T, Berlet M, Hopt UT (2010) Unplanned discharges from a surgical intensive care unit: readmissions and mortality. J Crit Care 25(3):375\u2013381","DOI":"10.1016\/j.jcrc.2009.09.009"},{"key":"9791_CR22","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1016\/j.cie.2015.10.002","volume":"90","author":"JM Molina-Pariente","year":"2015","unstructured":"Molina-Pariente JM, Hans EW, Framinan JM, Gomez-Cia T (2015) New heuristics for planning operating rooms. Computers & Industrial Engineering 90:429\u2013443","journal-title":"Computers & Industrial Engineering"},{"issue":"2","key":"9791_CR23","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1016\/j.ejor.2016.08.024","volume":"257","author":"V Roshanaei","year":"2017","unstructured":"Roshanaei V, Luong C, Aleman DM, Urbach D (2017) Propagating logic-based benders\u2019 decomposition approaches for distributed operating room scheduling. Eur J Oper Res 257(2):439\u2013455","journal-title":"Eur J Oper Res"},{"key":"9791_CR24","doi-asserted-by":"crossref","unstructured":"Fei H, Chu C, Meskens N (2009) Solving a tactical operating room planning problem by a column-generation-based heuristic procedure with four criteria. Ann Oper Res 166(1):91","DOI":"10.1007\/s10479-008-0413-3"},{"key":"9791_CR25","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/j.ijpe.2014.07.015","volume":"158","author":"Y Wang","year":"2014","unstructured":"Wang Y, Tang J, Fung RY (2014) A column-generation-based heuristic algorithm for solving operating theater planning problem under stochastic demand and surgery cancellation risk. Int J Prod Econ 158:28\u201336","journal-title":"Int J Prod Econ"},{"issue":"1","key":"9791_CR26","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1007\/s10479-008-0413-3","volume":"166","author":"H Fei","year":"2009","unstructured":"Fei H, Chu C, Meskens N (2009) Solving a tactical operating room planning problem by a column-generation-based heuristic procedure with four criteria. Ann Oper Res 166(1):91","journal-title":"Ann Oper Res"},{"issue":"4\u2013part\u20131","key":"9791_CR27","doi-asserted-by":"publisher","first-page":"802","DOI":"10.1287\/opre.1090.0791","volume":"58","author":"B Denton","year":"2010","unstructured":"Denton B, Miller A, Balasubramanian H, Huschka T (2010) Optimal allocation of surgery blocks to operating rooms under uncertainty. Oper Res 58(4\u2013part\u20131):802\u2013816","journal-title":"Oper Res"},{"issue":"2","key":"9791_CR28","doi-asserted-by":"publisher","first-page":"602","DOI":"10.1016\/j.ejor.2019.01.036","volume":"276","author":"J Zhang","year":"2019","unstructured":"Zhang J, Dridi M, El Moudni A (2019) A two-level optimization model for elective surgery scheduling with downstream capacity constraints. Eur J Oper Res 276(2):602\u2013613. https:\/\/doi.org\/10.1016\/j.ejor.2019.01.036","journal-title":"Eur J Oper Res"},{"issue":"1\u20132","key":"9791_CR29","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1007\/s10696-015-9213-7","volume":"28","author":"B Addis","year":"2016","unstructured":"Addis B, Carello G, Grosso A, Tanfani E (2016) Operating room scheduling and rescheduling: A rolling horizon approach. Flex Serv Manuf J 28(1\u20132):206\u2013232","journal-title":"Flex Serv Manuf J"},{"issue":"3","key":"9791_CR30","doi-asserted-by":"publisher","first-page":"1026","DOI":"10.1016\/j.ejor.2006.02.057","volume":"185","author":"M Lamiri","year":"2008","unstructured":"Lamiri M, Xie X, Dolgui A, Grimaud F (2008) A stochastic model for operating room planning with elective and emergency demand for surgery. Eur J Oper Res 185(3):1026\u20131037","journal-title":"Eur J Oper Res"},{"issue":"24","key":"9791_CR31","doi-asserted-by":"publisher","first-page":"7317","DOI":"10.1080\/00207543.2015.1056318","volume":"53","author":"J Tang","year":"2015","unstructured":"Tang J, Wang Y (2015) An adjustable robust optimisation method for elective and emergency surgery capacity allocation with demand uncertainty. Int J Prod Res 53(24):7317\u20137328","journal-title":"Int J Prod Res"},{"issue":"2\u20133","key":"9791_CR32","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1016\/j.orhc.2012.05.002","volume":"1","author":"JT Essen","year":"2012","unstructured":"Essen JT, Hans EW, Hurink JL, Oversberg A (2012) Minimizing the waiting time for emergency surgery. Operations Research for Health Care 1(2\u20133):34\u201344","journal-title":"Operations Research for Health Care"},{"issue":"3","key":"9791_CR33","doi-asserted-by":"publisher","first-page":"971","DOI":"10.1016\/j.ejor.2018.11.073","volume":"275","author":"M Vandenberghe","year":"2019","unstructured":"Vandenberghe M, De Vuyst S, Aghezzaf E-H, Bruneel H (2019) Surgery sequencing to minimize the expected maximum waiting time of emergent patients. Eur J Oper Res 275(3):971\u2013982","journal-title":"Eur J Oper Res"},{"key":"9791_CR34","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1016\/j.cie.2020.106686","volume":"148","author":"NO Aissaoui","year":"2020","unstructured":"Aissaoui NO, Khlif HH, Zeghal FM (2020) Integrated proactive surgery scheduling in private healthcare facilities. Computers & Industrial Engineering 148:106\u2013686","journal-title":"Computers & Industrial Engineering"},{"issue":"1","key":"9791_CR35","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1007\/s12063-020-00172-x","volume":"14","author":"Y Xiao","year":"2021","unstructured":"Xiao Y, Yoogalingam R (2021) Reserved capacity policies for operating room scheduling. Oper Manag Res 14(1):107\u2013122","journal-title":"Oper Manag Res"},{"key":"9791_CR36","unstructured":"Australian Institute of Health and Welfare (2019) MyHospitals Data. Accessed: 2024-10-21. https:\/\/www.aihw.gov.au\/reports-data\/myhospitals"}],"container-title":["Health Care Management Science"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10729-026-09791-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10729-026-09791-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10729-026-09791-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T08:57:37Z","timestamp":1790845057000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10729-026-09791-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":36,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["9791"],"URL":"https:\/\/doi.org\/10.1007\/s10729-026-09791-5","relation":{},"ISSN":["1386-9620","1572-9389"],"issn-type":[{"value":"1386-9620","type":"print"},{"value":"1572-9389","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"10 November 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 September 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare that they have no conflicts of interest.","order":1,"name":"Ethics","label":"Conflicts of Interest","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"42"}}