Cancelled elective operations: an observational study from a district general hospital

Sanjay, P.; Dodds, Anthony J.; Miller, Edward; Arumugam, P.J.; Woodward, Ann

doi:10.1108/14777260710732268

Cited by 89 publications

(88 citation statements)

References 9 publications

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“…4,[17][18][19][20] In our experience, the available data allow some categorization of reasons for cancellations into patient-, structure-and process-related factors, differences of which were sensitive to variations over time as well as between surgical specialties. Our strategy of categorization is similar to those in other reports, 18,19 and it could be useful to identify potentially more modifiable reasons for cancellation.…”

Section: Discussionmentioning

confidence: 99%

“…3 Cancellation rates vary not only between different hospital types and sizes, 1 but also depends significantly on surgical leslie et al specialty and individual surgeons. 4,5,19,20 Comparatively high cancellation rates have been reported in specific services, such as urology and otolaryngology, [19][20][21] perhaps due to a bias of those with complex and variable case durations. 20 Given the documented increase in wait times in urology, 9 further investigation in a contemporary urological setting appears justified given the nature and scope of our specialty in an aging population.…”

Section: Introductionmentioning

confidence: 99%

“…14 Targeting interventions in focused areas, such as manipulation of case sequence or initiating preoperative evaluations closer to the OR date, 15,16 appear to be ineffective given the wide-ranging reasons for cancellations. Although it is reported that most cancellations may be avoidable, 4,6,[17][18][19] a consistent and standardized method of documenting contributing factors is lacking. Although reasons for cancellation are generally patient-or hospitalinitiated, 4,17 we have categorized these at our institution as structure-related (e.g., no hospital bed), patient-related (e.g., patient unwell) or process-related (e.g., scheduling error) based on Donabedian's quality of care framework.…”

Section: Introductionmentioning

confidence: 99%

“…Although it is reported that most cancellations may be avoidable, 4,6,[17][18][19] a consistent and standardized method of documenting contributing factors is lacking. Although reasons for cancellation are generally patient-or hospitalinitiated, 4,17 we have categorized these at our institution as structure-related (e.g., no hospital bed), patient-related (e.g., patient unwell) or process-related (e.g., scheduling error) based on Donabedian's quality of care framework. 3 Cancellation rates vary not only between different hospital types and sizes, 1 but also depends significantly on surgical leslie et al specialty and individual surgeons.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] Despite much attention paid to pre-operative surgical preparation, day of surgery cancellations remain a major cause of inefficient use of operating room (OR) time and a drain on finite healthcare resources. [4][5][6] Cancellations also create a financial burden for patients in addition to potential emotional stress and a negative impact on perception of quality of care. [7][8][9][10] Monitoring cancellation rates and indentifying modifiable causes should be a priority for all stakeholders to assure the timely and efficient delivery of surgical care.…”

Section: Introductionmentioning

confidence: 99%

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Day of surgery cancellation rates in urology: identification of modifiable factors

Leslie

Beiko

Vlymen

2013

CUAJ

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Objective: Day-of-surgery cancellations have a negative effect on operating room (OR) resources, as well as on patient satisfaction and perception of quality of care. Given increasing wait times in a universal healthcare system and the nature of urological surgery in our aging population, it should be a priority to identify modifiable risks of OR cancellations to assure timely and efficient delivery of care. We explore the rate and reasons for elective surgery cancellations in a Canadian urological practice. Methods: We evaluated the rate and reason of urological surgery cancellation at a single academic institution, prospectively collected in our centre's Operating Room Scheduling Office System (ORSOS) database. Documented reasons for cancellations were divided into 3 components: (1) structural factors (e.g., no hospital bed); (2) patient factors (e.g., patient unwell); and (3) process factors (e.g., scheduling error). Rates and reasons for cancellations were compared to those of General Surgery and Gynecology. The documented reasons for cancellation in the ORSOS database were confirmed or extended by chart review and interviews with a subset of cancelled patients. Results: Between 2005 and 2009, 1544 out of 19 141 (8.07 %) elective surgical cases were cancelled within the three surgical specialties (general surgery, gynecology and urology); urology had the highest average rate of 9.53%. Non-oncological cases represented a higher percentage of cancelled cases (15%, p < 0.001) and overall rates varied significantly over time in urology compared to the other surgical specialties. Potentially modifiable, processrelated causes were by far the most common reason for cancellation (58.5%) and "standby" cases were a common cause of overall cancellation rates. Patient interviews confirmed the emotional and financial impact of cancellation; there was no overwhelming concern that clinical outcomes were negatively affected. Conclusions: This contemporary exploration of cancelled urological cases is consistent with previous reports, although variable over time and dependent on definitions used. Potentially modifiable, process-related factors appear to be most frequently associated with cancellation, although more thorough and detailed documentation is required to further mitigate inefficient OR use. We suggest that all OR cancellations should be considered to be adverse incidents to be monitored by institutions in a systematic fashion.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Day of surgery cancellation rates in urology: identification of modifiable factors

Leslie

Beiko

Vlymen

2013

CUAJ

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Phase 1 clinical study to assess the safety of a novel drug delivery system providing long‐term topical steroid therapy for chronic rhinosinusitis

Douglas

Psaltis

Rimmer

et al. 2019

Int Forum Allergy Rhinol

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Background Chronic rhinosinusitis (CRS) patients who fail medical management have few treatment options other than endoscopic sinus surgery (ESS). A novel biodegradable mometasone furoate drug delivery system (LYR‐210) providing continuous topical steroid therapy to sinonasal mucosa over 24 weeks was developed to treat unoperated CRS patients who have failed medical management prior to ESS. LYR‐210 was designed to slowly expand in the middle meatus, ensuring efficient drug delivery as mucosal swelling reduces. Methods A prospective, multicenter, open‐label study was conducted in 20 CRS subjects who were determined to be candidates for ESS. Under endoscopic guidance and topical anesthesia, LYR‐210 was placed in both middle meatuses. The primary endpoint was product‐related serious adverse events (SAEs) at 4 weeks. Additional assessments included plasma drug concentration, morning serum cortisol levels, intraocular pressures (IOPs), and Sino‐Nasal Outcome Test (SNOT‐22) scores. Results LYR‐210 was successfully placed bilaterally in 20 subjects (12 without nasal polyps and 8 with polyps) in an office setting. There were no product‐related SAEs through 24 weeks, at which point 86% of LYR‐210 depots were still retained in the middle meatus. Serum cortisol, IOP, and plasma drug concentrations supported systemic safety at all time points tested. Subjects experienced significant reductions in their SNOT‐22 scores as early as week 1, and this reduction persisted through week 24 (p < 0.01). Significant symptom improvement was achieved in the SNOT‐22 rhinologic, extranasal rhinologic, ear‐facial, psychological, and sleep dysfunction subdomains at 24 weeks (p < 0.05). Conclusion LYR‐210 is safe and well‐tolerated in ESS‐naive CRS patients and leads to sustained symptom improvement in patients.

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Cancelled Procedures: Inequality, Inequity and the National Health Service Reforms

Cookson

Jones

McIntosh³

2012

Health Economics

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Cancelled elective operations: an observational study from a district general hospital

Abstract: This paper is of value in that it is demonstrated that most cancellations of elective operations are due to patient-related causes and several changes are suggested to try and limit the impact of these cancellations on elective operating lists.

Cited by 89 publications

References 9 publications

Day of surgery cancellation rates in urology: identification of modifiable factors

Day of surgery cancellation rates in urology: identification of modifiable factors

Phase 1 clinical study to assess the safety of a novel drug delivery system providing long‐term topical steroid therapy for chronic rhinosinusitis

Cancelled Procedures: Inequality, Inequity and the National Health Service Reforms

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