Prevalence and Predictors of Cancellation of Elective Surgical Procedures at a Tertiary Hospital in Uganda: A Cross-Sectional Study

Abstract

Introduction. The cancellation of elective procedures has been shown to waste resources and to have the potential to increase morbidity and mortality among patients. This study aimed to determine the prevalence of the cancellation of elective surgical procedures and to identify the factors associated with these cancellations at Mulago Hospital, a large public hospital in Kampala, Uganda. Methods. A cross-sectional study was conducted from January 10, 2018, to February 20, 2018. We recruited patients of all ages who were admitted to surgical wards and scheduled for elective surgery. Data on patients’ demographic characteristics and diagnosis, as well as the specialty of the surgery, the planned procedure, the specific operating theatre, cancellation, and the reasons for cancellation were extracted and analyzed using logistic regression. Results. Of a total of 400 cases, 115 procedures were canceled—a cancellation prevalence of 28.8%. Orthopedic surgery had the highest cancellation rate, at 40.9% (n = 47). Facility-related factors were responsible for 67.8% of all cancellations. The most common reason for cancellation was insufficient time in the theatre to complete the procedure on the scheduled day. No procedures were canceled because of a lack of intensive care unit beds. There was a significant association between surgical specialty and cancellation (P<0.05) at multivariate analysis. Conclusion. The prevalence of cancellation of elective surgical procedures at Mulago Hospital was 28.8%, with orthopedic surgery having the highest cancellation rate. Two-thirds of the factors causing cancellations were facility-related, and more than 50% of all cancellations were potentially preventable. Quality-improvement strategies are necessary in the specialties that are susceptible to procedure cancellation because of facility factors.

Root causes of elective surgical case cancellation in Ethiopia: a systematic review and meta-analysis

“…Besides, management strategies or surgical settings might be similar in developing countries. However, the current study's finding is lower than a study conducted in Nigeria [23], Uganda [35] and Malawi [21]. This Table 2 Characteristics of included studies in the meta-analysis for the root causes of elective surgical case cancellation discrepancy might be due to findings of elective surgery cancellation vary widely because of study design; type of hospital, country, capacity, and patient type (inpatients vs. outpatients).…”

“…Based on the estimation of the root causes for elective surgical case cancellation, the most common identified cause was administration-related reason. The same report from the Kingdom of Saudi Arabia [17], Jordan [18], Uganda [35], and Malawi [21] showed that administration-related reasons found the most common causes of elective surgical case cancellation. This might be due to the reality is that surgical case cancellation can result in the financially under-utilization of theatres [2].…”

Global prevalence and reasons for case cancellation on the intended day of surgery: A systematic review and meta-analysis

“…The subgroup analysis also showed that the prevalence of cancellation was the highest in Sub-Saharan African region [ 5 , 15 , 25 , 35 , 56 , 63 ] 34% (95% confidence interval (CI): 26 to 42) followed by Latin America [ 14 , 43 , 47 , 51 , 53 , 59 , 66 ] 13% (95% confidence interval (CI): 8 to 19) were Burkina Faso and Ethiopia accounted for more than fifty percent from African region [ 5 , 33 ].…”

Elective Surgical Case Cancellation and Reasons in Ethiopia: A Systematic Review and Meta-Analysis

“…Besides, management strategies or surgical settings might be similar in developing countries, but lower than a study conducted in Nigeria [23], Uganda [35] and Malawi [21]. This discrepancy might be due to ndings of cancellation varying widely by study design; hospital type, country, and capacity; patient type (inpatients vs. outpatients).…”

“…Based on the estimation of the reason for elective surgical case cancellation, the most common identi ed reason was administration-related reasons. The same report from the Kingdom of Saudi Arabia [17], Jordan [18], Uganda [35], and Malawi [21] showed that administration-related reasons found the most common reasons of elective surgical case cancellation. This might be due to the reality is that surgical case cancellation can result in the nancially under-utilization of theatres [2].…”