Who operates after hours? An audit of the three highest volume intra-abdominal emergency procedures in a regional Australian Hospital.

Author : Malcolm Han Tong Zou

Abstract : Purpose/Introduction: Emergency operating patterns affect theatre access, staffing, and resource allocation, particularly in regional centres. We audited the three highest volume intra-abdominal emergency procedures at Rockhampton Hospital to describe timing and assess whether after-hours cases differed in duration or urgency. Methodology: A retrospective audit was performed of all emergency operations at Rockhampton Hospital from 1/11/24 to 1/11/25. The three highest volume intra-abdominal emergency procedures were caesarean section (n=259), appendicectomy (n=233), and cholecystectomy (n=115). Multivariate linear regression assessed associations between after-hours status (6 pm to 8 am) and procedure duration, adjusted for age and priority category. Logistic regression assessed whether after-hours cases were assigned more urgent priority categories. Results: The frequencies of caesarean sections, appendicectomies, and cholecystectomies occurring after-hours were 65%, 29%, and 17% respectively. Caesarean sections showed the greatest after-hours burden, with 36% commencing between 6 pm and midnight. Appendicectomies and cholecystectomies were concentrated in daytime hours, both peaking between 9 am and midday (27% each). After-hours caesarean sections were shorter than in-hours cases by 7.19 minutes (95% CI 2.25-12.13, p=0.004) and were more likely to receive a more urgent priority category (OR 2.66, 95% CI 1.55-4.62, p<0.001). After-hours appendicectomies were also shorter by 14.12 minutes (95% CI 6.55 21.69, p<0.001). No significant duration difference was seen for cholecystectomies (p=0.105). Conclusion/s: Caesarean section imposes the greatest after-hours theatre demand among the commonest intra-abdominal emergency procedures in our regional centre, whereas appendicectomy and cholecystectomy are predominantly daytime operations. These findings may inform theatre planning, rostering and prioritisation.

Keywords : Emergency Surgery; After-Hours Surgery; Theatre Utilisation; Regional Hospital; Rostering

Conference Name : International Conference on Surgery, Healthcare Systems and Policy (ICSHSP-26)

Conference Place : Sydney, Australia

Conference Date : 10th Sep 2026