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. 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. 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. 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.

中文翻译：

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急性护理手术（新 TACS）分类的新时机：WSES Delphi 共识研究

及时进入手术室进行急诊普外科 (EGS) 适应症仍然是全球面临的挑战，这在很大程度上是由手术室可用性和人员配置限制所驱动的。“急性护理手术的时机”(TACS) 分类先前已发布，以引入一种新工具来对 EGS 患者及时和适当地进入手术室进行分类。然而，TACS 分类的临床和操作有效性尚未在随后的验证研究中得到调查。本研究旨在改进 TACS 分类，并通过与国际专家的标准化德尔菲方法，就新 TACS 分类的适当使用达成进一步共识。这是由选定的国际专家小组使用 Delphi 方法对新 TACS 进行的验证研究。TACS 问卷被设计为基于网络的调查。共识协议水平确定为 ≥ 75%。集体共识协议被定义为所有参与者中最高李克特量表水平 (4-5) 的百分比总和。为每个提议的类别定义了外科急症和相关的临床情景。进行后续轮次，直到达成明确的共识水平。计算频率和百分比以确定每种外科疾病的一致性程度。进行了四轮投票。新的 TACS 分类提供 6 个颜色代码类别，这些类别与手术的精确时间、定义的场景和手术条件相关。WHITE 颜色代码类别被引入以快速（在一周内）重新安排取消或推迟的外科手术。血液动力学稳定性是在存在脓毒症/感染性休克的情况下对患者进行分层是否立即手术的主要工具。51 种外科疾病被包括在不同的优先级颜色代码类别中。新的 TACS 分类是一个全面、简单、清晰和可重复的分流系统，可用于评估患者和手术疾病的严重程度，减少进入手术室的时间，并管理急诊手术患者。一个“安全”的时间框架。通过将定义明确的外科疾病纳入不同颜色代码的优先级类别，并通过德尔菲共识进行验证，新的 TACS 改善了外科医生之间的沟通，