Assessing the Rates and Reasons of Elective Surgical Cancellations on the Day of Surgery: A Multicentre Study from Urban Indian Hospitals

Abstract

Background Cancellations of elective surgeries on the day of surgery (DOS) can lead to added financial burden and wastage of resources for healthcare facilities; as well as social and emotional problems to patients. These cancellations act as barriers to delivering efficient surgical services. Optimal utilisation of the available resources is necessary for resource-constrained low-and-middle-income countries (LMIC). This study investigates the rate and causes of cancellations of elective surgeries on the DOS in various surgical departments across ten hospitals in India. Methods A research consortium ‘IndSurg’ led by World Health Organisation Collaboration Centre (WHOCC) for Research in Surgical Care Delivery in LMICs, India conducted this multicentre retrospective cross-sectional study to analyse the cancellations of elective/planned surgical operations on DOS across urban secondary and tertiary level hospitals. We audited surgical records of a pre-decided period of six weeks for cancellations, documented relevant demographic information and reasons for cancellations. Results We analysed records from the participating hospitals, with an overall cancellation rate of 9.7% (508/5231) on the DOS for elective surgical operations. Of these, 74% were avoidable cancellations. A majority (30%) of these 508 cancellations were attributed to insufficient resources, 28% due to patient's refusal or failure to show-up, and 22% due to change in patient's medical status. Conclusion We saw a preponderance of avoidable reasons for elective surgery cancellations. A multidisciplinary approach with adequate preoperative patient counselling, timely communication between the patients and caregivers, adequate preoperative anaesthetic assessment, and planning by the surgical team may help reduce the cancellation rate.

Magnitude and reasons of surgery cancellation among elective surgical cases in Wolaita Sodo University Comprehensive Specialized Hospital, Southern Ethiopia, 2021

“…In this research, the prevalence of cancelation was high in the department of General Surgery (29.03%) followed by Gynecology/obstetric surgery (26.49%), Orthopedics (22.64%), Ophthalmology (12.5%), Maxillofacial (12.5%). This is supported by studies in Ethiopia [1,8,13], and India [35]. Studies in Black Lion hospital [11] and Saudi Arabia [29] orthopedic surgery were the highest cancellation rate across the department.…”

“…The third common cause of cancellation was surgeon-related factor 21(25.3%), especially over-scheduled elective surgery cases were major surgeon-related factors. This is supported by studies conducted in Ethiopia [8,13,36], Saudi Arabian [29], and India [35]. Since this study is a cross-sectional study design, all limitations associated with the cross-sectional study may apply.…”

COVID-19 effects on operating room cancellations at a pediatric tertiary care hospital: A retrospective cohort study

“…Same-day operating room (OR) cancellation is a significant issue affecting hospitals world-wide [ 1 , 2 ]. Cancellations often waste valuable OR time causing decreased overall OR efficiency.…”

Elective surgery cancellations due to suboptimal medicine management: a retrospective single site study

“…They represent a financial burden due to significant loss of hospital revenue and wastage of resources 3 . Cancellations have emotional, social, practical, and financial problems for patients and their families 3–5 . Patients who have had their surgery cancelled report feelings of anger, rejection, and anxiety, with added physical/psychosomatic symptoms in the extended waiting period until a new surgery date is clarified 4 .…”

“…Patients who have had their surgery cancelled report feelings of anger, rejection, and anxiety, with added physical/psychosomatic symptoms in the extended waiting period until a new surgery date is clarified 4 . The overall cancellation rate for elective surgery cancellations has been reported in the literature as 9.7% ( n = 508 cancelled surgeries from 5231 total surgeries booked) 5 . A study conducted in two public hospitals in England reported the cancellation rate for same day of surgery cancellations (elective and emergency) as 5.2% 3 .…”