TY - JOUR
T1 - The new timing in acute care surgery (new TACS) classification
T2 - a WSES Delphi consensus study
AU - WSES TACS panel of experts
AU - De Simone, Belinda
AU - Kluger, Yoram
AU - Moore, Ernest E.
AU - Sartelli, Massimo
AU - Abu-Zidan, Fikri M.
AU - Coccolini, Federico
AU - Ansaloni, Luca
AU - Tebala, Giovanni D.
AU - Di Saverio, Salomone
AU - Di Carlo, Isidoro
AU - Sakakushev, Boris E.
AU - Bonavina, Luigi
AU - Sugrue, Michael
AU - Galante, Joseph M.
AU - Ivatury, Rao
AU - Picetti, Edoardo
AU - Chirica, Mircea
AU - Wani, Imtiaz
AU - Bala, Miklosh
AU - Sall, Ibrahima
AU - Kirkpatrick, Andrew W.
AU - Shelat, Vishal G.
AU - Pikoulis, Emmanouil
AU - Leppäniemi, Ari
AU - Tan, Edward
AU - Broek, Richard P.G.ten
AU - Gurmu Beka, Solomon
AU - Litvin, Andrey
AU - Chouillard, Elie
AU - Coimbra, Raul
AU - Cui, Yunfeng
AU - De’ Angelis, Nicola
AU - Sganga, Gabriele
AU - Stahel, Philip F.
AU - Agnoletti, Vanni
AU - Rampini, Alessia
AU - Shelat, Vishal
AU - Damaskos, Dimitrios
AU - Carcoforo, Paolo
AU - Biffl, Walter L.
AU - Bonavina, Luigi
AU - Hecker, Andreas
AU - Di Carlo, Isidoro
AU - Galante, Joseph M.
AU - Kirkpatrick, Andrew
AU - Sartelli, Massimo
AU - Picetti, Edoardo
AU - Coimbra, Raul
AU - Di Salomone, Salomone
AU - Balogh, Zsolt
N1 - Publisher Copyright:
© 2023, The Author(s).
PY - 2023/12/1
Y1 - 2023/12/1
N2 - Background: Timely access to the operating room for emergency general surgery (EGS) indications remains a challenge across the globe, largely driven by operating room availability and staffing constraints. The “timing in acute care surgery” (TACS) classification was previously published to introduce a new tool to triage the timely and appropriate access of EGS patients to the operating room. However, the clinical and operational effectiveness of the TACS classification has not been investigated in subsequent validation studies. This study aimed to improve the TACS classification and provide further consensus around the appropriate use of the new TACS classification through a standardized Delphi approach with international experts. Methods: This is a validation study of the new TACS by a selected international panel of experts using the Delphi method. The TACS questionnaire was designed as a web-based survey. The consensus agreement level was established to be ≥ 75%. The collective consensus agreement was defined as the sum of the percentage of the highest Likert scale levels (4–5) out of all participants. Surgical emergency diseases and correlated clinical scenarios were defined for each of the proposed classes. Subsequent rounds were carried out until a definitive level of consensus was reached. Frequencies and percentages were calculated to determine the degree of agreement for each surgical disease. Results: Four polling rounds were carried out. The new TACS classification provides 6 colour-code classes correlated to a precise timing to surgery, defined scenarios and surgical condition. The WHITE colour-code class was introduced to rapidly (within a week) reschedule cancelled or postponed surgical procedures. Haemodynamic stability is the main tool to stratify patients for immediate surgery or not in the presence of sepsis/septic shock. Fifty-one surgical diseases were included in the different colour-code classes of priority. Conclusion: The new TACS classification is a comprehensive, simple, clear and reproducible triage system which can be used to assess the severity of the patient and the surgical disease, to reduce the time to access to the operating room, and to manage the emergency surgical patients within a “safe” timeframe. By including well-defined surgical diseases in the different colour-code classes of priority, validated through a Delphi consensus, the new TACS improves communication among surgeons, between surgeons and anaesthesiologists and decreases conflicts and waste and waiting time in accessing the operating room for emergency surgical patients. Graphical Abstract: [Figure not available: see fulltext.].
AB - Background: Timely access to the operating room for emergency general surgery (EGS) indications remains a challenge across the globe, largely driven by operating room availability and staffing constraints. The “timing in acute care surgery” (TACS) classification was previously published to introduce a new tool to triage the timely and appropriate access of EGS patients to the operating room. However, the clinical and operational effectiveness of the TACS classification has not been investigated in subsequent validation studies. This study aimed to improve the TACS classification and provide further consensus around the appropriate use of the new TACS classification through a standardized Delphi approach with international experts. Methods: This is a validation study of the new TACS by a selected international panel of experts using the Delphi method. The TACS questionnaire was designed as a web-based survey. The consensus agreement level was established to be ≥ 75%. The collective consensus agreement was defined as the sum of the percentage of the highest Likert scale levels (4–5) out of all participants. Surgical emergency diseases and correlated clinical scenarios were defined for each of the proposed classes. Subsequent rounds were carried out until a definitive level of consensus was reached. Frequencies and percentages were calculated to determine the degree of agreement for each surgical disease. Results: Four polling rounds were carried out. The new TACS classification provides 6 colour-code classes correlated to a precise timing to surgery, defined scenarios and surgical condition. The WHITE colour-code class was introduced to rapidly (within a week) reschedule cancelled or postponed surgical procedures. Haemodynamic stability is the main tool to stratify patients for immediate surgery or not in the presence of sepsis/septic shock. Fifty-one surgical diseases were included in the different colour-code classes of priority. Conclusion: The new TACS classification is a comprehensive, simple, clear and reproducible triage system which can be used to assess the severity of the patient and the surgical disease, to reduce the time to access to the operating room, and to manage the emergency surgical patients within a “safe” timeframe. By including well-defined surgical diseases in the different colour-code classes of priority, validated through a Delphi consensus, the new TACS improves communication among surgeons, between surgeons and anaesthesiologists and decreases conflicts and waste and waiting time in accessing the operating room for emergency surgical patients. Graphical Abstract: [Figure not available: see fulltext.].
KW - Classification
KW - Delay in surgery
KW - Delphi method
KW - Emergency surgery
KW - Healthcare system
KW - Operating room management
KW - Priority
KW - Time to surgery
KW - Timing in acute care surgery (TACS)
KW - Triage
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U2 - 10.1186/s13017-023-00499-3
DO - 10.1186/s13017-023-00499-3
M3 - Article
C2 - 37118816
AN - SCOPUS:85157971589
SN - 1749-7922
VL - 18
JO - World Journal of Emergency Surgery
JF - World Journal of Emergency Surgery
IS - 1
M1 - 32
ER -