Prevalence and factors associated with cancellation and deferment of elective surgical cases at a rural private tertiary hospital in Western Uganda: a cross sectional study

Abstract

Introduction the cancellation of elective surgery is still a worldwide challenge and this is associated with emotional and economical trauma for the patients and their families as well as a decrease in the efficiency of the operating theatre. This study aimed at determining the prevalence and factors associated with cancellation and deferment of elective surgery in a rural private tertiary teaching hospital in Western Uganda. Methods a cross-sectional study design was conducted. Data was collected from 1 st July 2019 to 31 st December 2019. Patients scheduled for elective surgery and either cancelled or deferred on the actual day of surgery were included in the study. Statistical analysis was done using STATA version 15. Results four hundred patients were scheduled for elective surgery during the study period, among which 90 (22.5%) were cancelled and 310 (78.5%) had their surgeries as scheduled. The highest cancellation of elective surgical operations was observed in general surgery department with 81% elective cases cancelled or deferred, followed by orthopedic department 10% and gynecology department 9%. The most common reasons for cancellation were patient-related (39%) and health worker-related (35%) factors. Other factors included administrative (17%) and anesthesia related factors (9%). Cancellation was mainly due to lack of finances which accounted for 23.3% of the patients, inadequate patient preparation (16.6%) and unavailability of surgeons (15.5%). Major elective surgeries were cancelled 1.7 times more than minor electives surgeries [adjusted prevalence ratio 1.7 (95%CI: 1.07-2.73) and p-value: 0.024]. Conclusion cancellation and deferment of elective surgeries is still of a major concern in this private rural tertiary hospital with most of the reasons easily preventable through proper scheduling of patients, improved communication between surgical teams and with patients; and effective utilization of available resources and man power.

Magnitude and Factors Associated with Elective Surgery Cancellation

“…In this study out of all departments general surgery had the highest rate of cancellation 19 (50%) and these findings consistent with Asela Teaching Hospital, a rural private tertiary hospital in Western Uganda, Nigeria, Tanzania and Woliata Sodo Hospital, Nort-east India [2,26,30,32,40,41] but in some studies like TikurAnbesa Specialized Hospital, Hawasa Comprehensive Hospital, and Tertiary Hospital in Uganda Orthopedic surgery cancelation has the highest rate of cancelation [15,42,43]. This could be due high burden of patients under general surgery departments which may result in inadequate investigation, lack of ICU beds and operation theatre equipment.…”

“…This study found that the most common reason for the cancellation was facility/ administrative related which was 40% and it parallel with studies in Tertiary Hospital in Uganda, and Tanzania, Systematic review in Ethiopia, Urban Indian Hospitals [28,42,44,45], but in other studies like the Middle East, rural private tertiary hospitals in Western Uganda, Tikur Anbesa Hospital and Nigeria Teaching Hospital patient-related reasons were the most frequently mentioned reason for cancellation [15,32,33,40]. These causes included lack of theatre space and facilities, unavailability of OT equipment, shortage of logistics Shortage of OR materials, lack of blood prepared and hospital sewerage systems.…”

Evaluation of the operation scheduling application (SIJO) in an effort to reduce the number of cancellation of operations at Dr. Mohammad Hoesin Hospital Palembang

“…Okeke (2020) found that the 47.5% of the surgery cancellations were attributed to the patient-related factors, including unavailability of the blood products. 13 Kajja (2014) also found that unavailability of the surgical theater was responsible to the surgery cancellation of the surgery in 33.1% of the cases, while the lack of blood products were related to the cancellation of the surgery in 30.1% of the cases. 14 On the other hand, Vahwere (2021) found that only 3.3% of the surgery was cancelled due to the lack of the blood products.…”

Outcomes and Disposition of Patients After Case Cancellation on Day of Surgery for Reasons Attributed to Medical or Anesthetic Care: A Retrospective Cohort Analysis

“…[1][2][3] Patients and their families experience inconvenience from a late surgical cancellation, and the financial and logistic impact can be substantial to facilities, which may deal with extended hospital stays and costly repetition of preoperative preparation. [3][4][5] Family members also often do not understand the reasoning behind day-of-surgery case cancellations and require extensive education regarding perioperative risk factors such as potential cardiovascular risk. 6 Analysis of same-day surgical cancellations is important to be conducted by anesthesia, surgical, and administrative personnel, to prevent future costly cancellations.…”