Cancelled total hip arthroplasty and knee arthroplasty: a retrospective analysis of 1003 patients

Abstract

Background The aim of the present study is to analyze the hospital length of stay (LOS), total hospital expense (THE), reasons, and subsequent fate of patients who had a total joint arthroplasty (TJA) cancelled.Methods In December 2020, we retrospectively reviewed a consecutive series of 18,508 patients who underwent primary total hip arthroplasty or knee arthroplasty between January 2009 and December 2018. Patients with unexpected cancellations of scheduled TJA surgeries were identified. LOS, THE, reasons for cancellations, and the number of patients who eventually performed arthroplasty were recorded.Results A total of 1,003 (5.4%) participants had scheduled TJA surgeries cancelled, which included 23 (2.3%) with two cancellations and 980 (97.7%) with one cancellation. The median LOS and THE of cancellations were 4 days (interquartile range [IQR] 3–7) and 4139 RMB (IQR 2611-6583.5), respectively. There were 720 patients (71.8%) who were cancelled due to medical-related reasons. Compared to non-medically related cancellation, medical-related cancellation had a higher age (60.9 vs 54.2, p < 0.001), LOS (5 vs 3, p < 0.001), and THE (4862 vs 2661, p < 0.001); meanwhile, the latter had a higher percentage of two cancellations (3.2% vs 0.0%, p = 0.002). During the follow-up, three hundred and twenty-three (32.3%) patients finally performed joint replacement in our institution, and the median time interval between the originally scheduled date of surgery and the actual date of surgery was 94 days (IQR 46-275.5).Conclusions This study suggests that the cancellation rate is relatively high in TJA practice, and medical-related cancellations are the most common. On the other hand, cancelling the operation will result in huge additional costs for patients and increased length of non-surgical hospital stay. Given that many of the reasons for cancellation are modifiable, a physician-guided pre-admission assessment is necessary to erase the concerns before the patient is admitted. Meanwhile, to prevent further delays, attention should be paid to patients whose TJA procedures have been cancelled and help them get their procedures rescheduled in a timely manner.