Evaluating factors associated with the cancellation and delay of elective surgical procedures: a systematic review

Abstract

Background Elective surgery cancellation is considered a fundamental problem in health care services—it causes considerable disruption to patient flow, further eroding often already stretched operating capacity, and consequentially reduces both hospital performance and patient satisfaction. This research presents a systematic review (SR) of the reasons for surgery cancellation among different hospitals and countries. By highlighting these causes, we identify how to reduce cancellations thereby improving the use of surgical capacity and resources and create a more predicable patient flow. Methods A systematic review was performed on elective surgery cancellation in compliance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) and assessing the methodological quality of systematic review with Measurement Tool to Assess Systematic Reviews (AMSTAR) guidelines. Results There are different reasons for surgery cancellation that vary between hospitals. This SR demonstrates that hospital-related causes (e.g., unavailable operation room time, inappropriate scheduling policy, lack of beds) are the primary reason for surgery cancellation, followed by work-up related causes (e.g., medically unfit, changes in the treatment plan), and patient-related causes (e.g., absence of a patient, patient refusal). Conclusion This review demonstrates the main causes for surgery cancellation can be controlled by hospital managers, who can aim to improve areas such as patient flow and capacity management. Ultimately, this will improve the quality of healthcare delivered by hospitals.

Risk Factors for Non-Adherence to Medications That Affect Surgery: A Retrospective Study in Japan

“…A systematic review has reported that the main causes of surgery cancellations were hospital-related causes, such as improper scheduling, and patient-related causes, such as patient refusal. 7 In Japan, 19 cases of medical accidents involving the continued administration of medications that were supposed to be withdrawn before a hematological procedure were reported between 2010 and 2015, including three that could have resulted in patient disability. 8 Perioperative bleeding is recognized as a major risk factor for subsequent mortality.…”

Self‐withdrawal from scheduled bariatric surgery: Qualitative study exploring patient and healthcare provider perspectives

“…These findings have been observed in previous research examining patient no-shows for elective surgery, which also acknowledge the difficulty in resolving this issue. [12][13][14] As BS is a limited resources for patients living with severe obesity in Canada, 32 United States, 33 and outside of North America 34 with fewer than 1% of all eligible patients receiving this intervention, 35 The use of peer mentors could be a cost-effective option to supplement professional support, and has been suggested by both patients and HCPs to help alleviate patient anxiety. The need for peer mentors has been previously reported among patients waiting for BS.…”

“…10,11 These fears were often made worse after reading about experiences on Internet support groups. 12,13 Finally, patients and HCPs identified logistical issues such as costs related to mandatory pre-operative meal-replacement or postoperative vitamin supplementation, 14,15 a lack of personal supports for post-operative care, 16,17 a major life event, 18,19 and proximity to the BCoE 20 as major factors contributing to the decision to selfwithdraw from scheduled BS.…”

“…Moreover, cancellations of scheduled surgical procedures reduce clinic efficiency, increase healthcare costs, and have a deleterious effect on healthcare providers' productivity. [12][13][14] Several studies have examined patients' demographic factors associated with attrition, finding that males, 3,5,6,9,15 individuals with active substance use, 9,15 lower socioeconomic status, 15,16 those with fewer obesity-related comorbidities, 8 a Body Mass Index >40 kg/m 2 , 9 individuals with indigenous ancestry, 5 minority ethnic groups 15 and immigrants 16 were less likely to undergo BS compared to their peers.…”

“…As such, high rates of attrition represent an opportunity to critically reflect on the challenges faced by patients living with obesity who are contemplating self‐withdrawal from the programme, particularly during or after completing the lengthy MAOP. Moreover, cancellations of scheduled surgical procedures reduce clinic efficiency, increase healthcare costs, and have a deleterious effect on healthcare providers' productivity 12–14 …”