{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T06:07:27Z","timestamp":1789106847261,"version":"build-2803163510"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Decision-to-delivery interval (DDI) is widely used to audit emergency cesarean delivery, but total DDI does not distinguish workflow performance from risk-based clinical decisions. This exploratory study compared DDI between urgency categories and quantified the contribution of individual process components to the observed difference.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center retrospective cohort study included 80 category I or II emergency cesarean deliveries between March 1, 2024, and October 31, 2025. DDI was divided into five mutually additive intervals. Between-category mean differences and component contributions were estimated using 50,000 stratified bootstrap resamples. Anesthesia type was considered a potential process-pathway variable because urgency may influence anesthetic strategy, which may in turn affect pre-incision workflow and total DDI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Median DDI was 18.0\u2005min, and 78 cases (97.5%) achieved delivery within 30\u2005min. Median DDI was shorter in category I than category II cases [14.0 (10.0\u201316.0) vs. 19.0 (17.0\u201323.0) minutes;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001]. The reconstructed mean difference was 6.31\u2005min (95% bootstrap CI, 3.85\u20138.73). The anesthesia-to-incision interval differed by 5.24\u2005min (95% CI, 4.04\u20136.39) and accounted for 83.1% of the observed mean difference. General anesthesia was used in 73.7% of category I cases and 8.2% of category II cases. In the primary model adjusted for shift and major indication, category II urgency was associated with a 6.55-minute longer DDI (95% CI, 3.86\u20139.25).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Most emergency cesarean deliveries met the 30-minute reference threshold, and the anesthesia-to-incision interval accounted for most of the observed DDI difference between urgency categories. These exploratory findings support risk-stratified, process-based DDI audit but do not establish a causal effect of any individual interval.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1913793","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T05:29:25Z","timestamp":1789104565000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The anesthesia-to-incision interval accounts for most of the observed difference in decision-to-delivery time between urgency categories during emergency cesarean delivery: a single-center retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Guoqiang","family":"Zhao","sequence":"first","affiliation":[{"name":"Department of Obstetrics, Shaoxing Maternity and Child Health Care Hospital","place":["Shaoxing, 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