Emergency General Surgery Pathways in Romania Compared with European Acute Care Surgery Standards: A comparative review

Catalin Cosma; Tereza-Maria Rideg; Calin Molnar; Vladimir Bacarea Constantin

doi:10.33695/rojes.v7i1.141

Catalin Cosma SCJU Tg.Mures Chirurgie 1
Tereza-Maria Rideg George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures,SCJU Tg.Mures Chirurgie 1
Calin Molnar George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures,SCJU Tg.Mures Chirurgie 1
Vladimir Bacarea Constantin George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures,SCJU Tg.Mures Chirurgie 1

DOI: https://doi.org/10.33695/rojes.v7i1.141

Keywords: Emergency General Surgery, Acute Care Surgery, Emergency Surgery, Healthcare Organization, Surgical Pathways, Quality Indicators;, Quality Improvement

Abstract

Introduction: Emergency General Surgery (EGS) constitutes a major component of modern surgical practice and is associated with substantial morbidity, mortality, and healthcare resource utilization. In response to the growing complexity of emergency surgical patients, several European countries have progressively adopted Acute Care Surgery (ACS) models characterized by dedicated emergency surgical teams, standardized clinical pathways, rapid access to diagnostic resources, and continuous quality assessment. Romania continues to provide nationwide emergency surgical care through a heterogeneous hospital network; however, the degree of alignment between current Romanian EGS pathways and contemporary European ACS standards remains insufficiently explored. This review aimed to compare the organizational structure of emergency general surgery services in Romania with established European ACS models and to identify opportunities for future system improvement.
Material & Method: A narrative comparative review was performed using evidence from PubMed, Scopus, Web of Science, European Surgical Society guidelines, national healthcare reports, and policy documents published between 2008 and 2025. Key recommendations from the World Society of Emergency Surgery (WSES), the European Society for Trauma and Emergency Surgery (ESTES), National Emergency Laparotomy Audit (NELA) reports, and Romanian healthcare strategic documents were analyzed. Comparative evaluation focused on workforce organization, emergency patient pathways, diagnostic imaging availability, operating room access, critical care integration, implementation of minimally invasive surgery, quality indicators, and national audit systems.
Results: European ACS systems are increasingly characterized by consultant-led emergency surgery services, dedicated ACS teams, protected emergency operating theater access, standardized triage protocols, multidisciplinary perioperative care, and participation in national quality registries. In contrast, Romanian emergency surgical care is predominantly organized through traditional on-call models, with significant variability in staffing patterns, resource allocation, and access to dedicated emergency surgical infrastructure between institutions. While Romanian tertiary referral centers have achieved high levels of expertise in emergency and minimally invasive surgery, national implementation of standardized ACS pathways, emergency surgery quality indicators, and outcome benchmarking remains limited. Furthermore, no dedicated national emergency surgery registry currently exists to facilitate systematic performance evaluation and quality improvement.
Conclusion: Romanian emergency general surgery services provide comprehensive emergency surgical care and share several fundamental principles with European ACS systems. Nevertheless, important organizational differences persist, particularly regarding dedicated ACS structures, quality monitoring frameworks, and national benchmarking mechanisms. Adoption of standardized emergency surgery pathways, protected emergency operating resources, multidisciplinary ACS models, and national audit programs may enhance surgical outcomes and facilitate closer alignment with contemporary European standards.

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