Causes of cancellations on the day of surgery at a Tertiary Teaching Hospital

Abstract

BackgroundCancellation of elective scheduled operations on the day of surgery leads to an inefficient use of operating room (OR) time and a waste of resources. It also causes inconvenience for patients and families. Moreover, day of surgery (DOS) cancellation creates logistic and financial burden associated with extended hospital stay and repetitions of pre-operative preparations as well as opportunity costs of lost time and missed income. The objective of this study is to establish the rate of elective surgical cases cancellations on the day of surgery and the reasons for these cancellations stratified by avoidable versus unavoidable within a tertiary care teaching hospital in Beirut, Lebanon as well as recommend appropriate solutions.MethodThis is a prospective audit of the operation theatre list over a period of eight months (January 1, 2013-August 30, 2013). All patients scheduled to undergo elective surgeries at the hospital from January-August 2013 were included. An assigned OR staff recorded the cancelled cases in real time. The assigned staff confirmed the cancellation reason and added additional explanation if necessary by calling patients or through direct inquiry of clerical and/or clinical staff the following day. A Pareto chart was constructed to prioritize the reasons that accounted for 80 % of the avoidable surgical cancellations.ResultsFor the given study period, 5929 elective surgeries were performed, of which 261 cases (4.4 %) were cancelled on the day of surgery. 187 cases (or 71.6 %) were judged as potentially avoidable cancellations versus 74 (28.4 %) that were judged as unavoidable. Of the 187 potentially avoidable cancellations, lack of financial clearance, incomplete medical evaluation, patient not showing up for surgery, and OR behind schedule accounted for almost 80 % of the causes.ConclusionThis study showed that the majority of cancellations were deemed avoidable and hospital related. A day of surgery cancellation rate less than 2 % is attainable. Determining the major avoidable contributors to DOS cancellations is an essential first step to developing appropriate interventions to improve operating theater efficiency. Recommended interventions were presented accordingly.

Economic and psychological burden of scheduled surgery cancellation in a sub-Saharan country (Burkina Faso)

“…The incidence of elective surgical cancellations has been reported in the literature to range from 1.87% to 40%. 1,11,18 The total cancellation rate was 21.9% in our study, comparable to the rate found by Chaylia et al 18 in Tanzania, which was 21%. The high rate of cancellation in our study may be partly due to including all surgical specialties.…”

“…Mutwali et al 22 found that 68.3% were patient-related and then anaesthesia decisions (33.3%). Other authors 1,26,27 found that work-up and/or medical issues were the most common causes for DOS cancellation.…”

“…Day-of-surgery cancellation (DOSC) remains an indicator of quality of care and management. 1 DOSC causes an inefficient use of the operating theatre, and is a waste of time and resources for patients and their families. 2 It increases healthcare costs, and results in theatre inefficiency and financial loss, lost personal income 3 and emotional distress for patients.…”

Role of telehealth in perioperative medicine for regional and rural patients in Queensland

“…Prior to the introduction of POM telehealth services, the last‐minute cancellation rate at our hospital for outreach patients was reported to be as high as 10% . Worldwide last‐minute cancellation rates are highly variable and are estimated to be between 1.96 and 24% . Our low cancellation rate is attributable to the highly selected group of patients who were assessed to be suitable and optimised for surgery by a team of experienced clinicians.…”

“…Similar findings have been reported in previous studies. Kaddoum et al showed that patients with multiple medical comorbidities were more likely to be cancelled on the day of surgery as they were not identified preoperatively for optimisation . Therefore, a thorough preoperative assessment for patients with multiple medical comorbidities can prevent a last‐minute cancellation.…”