The Effect of Hospital Size and Surgical Service on Case Cancellation in Elective Surgery

Schuster, Martín; Neumann, Christian; Neumann, Konrad; Braun, J.; Geldner, Goetz; Martin, Joerg; Spies, Claudia; Bauer, Martin

doi:10.1213/ane.0b013e318222be4d

Cited by 91 publications

(78 citation statements)

References 19 publications

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“…From the analysis of the results emerged the percentage of surgery cancellations in the service under study (6.79%), considerably lower than that presented by German hospitals (12.4%) (15) and Brazilian hospitals (16.1% (25) a 17.3% (7) ) with the same university hospitals characteristics.…”

Section: Discussionmentioning

confidence: 67%

“…This type of health institution was indicated by a study as having a 2.23 times higher percentage of surgical cancellations when compared to medium and small community hospitals (5.0%) (15) . However, this study indicates the need for the manager to remain motivated to reduce the rate of surgical cancellations, even though it is below the parameters of other national and international institutions.…”

Section: Discussionmentioning

confidence: 99%

“…The study pointed out that those expenses could be avoidable, as long as the problems regarding flaws in administrative planning and mismanagement of the SC were fixed (1) . Several factors contribute to surgical cancellations: patient absence (1,10) ; unfavorable clinical conditions, mainly regarding decompensated chronic diseases, such as systemic arterial hypertension (SAH) and diabetes, in addition to lack of preoperative clinical exams (1,(10)(11) ; overrun of surgery time (10)(11)(12) ; non-availability of hospital bed (10) ; lack of articulation between surgical scheduling and the multipurpose team and a lack of computerization, which may cause errors leading to unnecessary cancellations (13)(14) ; type of hospital (university hospitals) (15) and of surgery (general surgery) (16) . Among the strategies proposed by the literature to reduce surgery cancellations are: pre-anesthetic or preoperative consultations (1,17) ; telephone confirmation of patient attendance two days before the procedure (10) ; restructuring of the work process, involving healthcare staff, information technology and mid-level professionals (18) .…”

Section: Introductionmentioning

confidence: 99%

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Cancellation of elective surgeries in a Brazilian public hospital: reasons and estimated reduction

Santos

Bocchi

2017

Rev. Bras. Enferm.

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Objective: To characterize cancellations of elective surgeries according to clinical and non-clinical reasons, as well as to verify seasonal influence and determine the estimated reduction of the index. Method: Quantitative, descriptive and retrospective study with secondary data extracted from the Public Hospital of the State of São Paulo database. Results: Out of the 8,443 (100%) elective surgeries scheduled, 7,870 (93.21%) were performed and 573 (6.79%) were canceled. Out of these 573 (100%) people, 48.33% were canceled for clinical reasons and 46.40% were for non-clinical reasons. Among the non-clinical reasons for surgery cancellations, those related to medical reasons stood out: at the request of the surgeon/change of approach (17.93%), followed by non-hospitalized patient (8.96%). There was no indication of seasonality regarding the reasons for cancellation in the assessed period. Conclusion: Although the rate of elective surgeries cancellations is lower than that of other hospitals with similar characteristics, it is still possible to reduce it from 6.79% to 1.36%, considering that 80% of the reasons for cancellation are avoidable.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cancellation of elective surgeries in a Brazilian public hospital: reasons and estimated reduction

Santos

Bocchi

2017

Rev. Bras. Enferm.

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“…Various interventions have been instituted in some centers aimed at reducing the Day of surgery case cancellation rates such as institution of preadmission clinics aimed at optimizing patients for surgeries [14] [15]. Case cancelation rate has been noted to vary with the hospital size and the type of service offered [16]. Of interest in developing countries is the perceived inefficiencies in the Public health system compared to the Private set ups.…”

Section: Introductionmentioning

confidence: 99%

Day of Surgery Cancellation in Urology at a Public Tertiary Hospital and a Private Specialist Hospital

Kyei¹,

Mensah²,

Bray³

et al. 2017

OJU

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Background: There is a high variability in the reasons for cancellation of elective urological surgery cases. Case cancellation rate is expected to be high in the Public Health System with perceived inefficiencies compared to private facilities in the same developing economy. Aims and Objectives: This comparative analysis was to determine the case cancellation rate and the reasons for cancellation of elective urological surgeries in a public tertiary hospital and a private specialist hospital in Accra. This is intended to form a basis for interventions aimed at reducing the case cancellation rate. Methods: This was a retrospective analysis of prospectively collected data on Day of Surgery cancelled elective urological cases from September 2014 to October 2015 at the urology unit of the Korle-Bu Teaching Hospital (KBTH), a public Tertiary Hospital and the Trust Specialist Hospital (TSH), a privately managed hospital in Accra. The reasons for case cancellation were categorized into structural factors, patient factors and process factors. Results: There was no significant difference between the case cancellation rate for elective urological cases at KBTH and the TSH which were 20.8% and 17.1% respectively (p = 0.317). For KBTH, the reasons for cancellation of elective urological cases were due to structural factors in 11/117 (9.4%), patient factors in 15/117 (12.8%) and process factors in 91/117 (77.8%) which was due mainly to surgery running late. At the TSH, the reasons were due to structural factors in 1/29 (3.4%), patient factors in 27/29 (93.1%) mainly due to patient not turning up and process factors in 1/29 (3.4%). Conclusion: The case cancellation rate of elective urological surgeries in both the Public Tertiary Hospital and the Private Specialist Hospital were high with no significant difference between the two. However, in the Public Tertiary Hospital, process factors predominated as the cause of these cancellations while patient factors were the predominant cause 23in the privately managed facility. Exposure of theater managers in public facilities to management practices in privately run facilities should be encouraged to help improve the efficiency of the public facilities.

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“…[1][2][3] Despite much attention paid to pre-operative surgical preparation, day of surgery cancellations remain a major cause of inefficient use of operating room (OR) time and a drain on finite healthcare resources. [4][5][6] Cancellations also create a financial burden for patients in addition to potential emotional stress and a negative impact on perception of quality of care.…”

Section: Introductionmentioning

confidence: 99%

Day of surgery cancellation rates in urology: identification of modifiable factors

Leslie

Beiko

Vlymen

2013

CUAJ

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Objective: Day-of-surgery cancellations have a negative effect on operating room (OR) resources, as well as on patient satisfaction and perception of quality of care. Given increasing wait times in a universal healthcare system and the nature of urological surgery in our aging population, it should be a priority to identify modifiable risks of OR cancellations to assure timely and efficient delivery of care. We explore the rate and reasons for elective surgery cancellations in a Canadian urological practice. Methods: We evaluated the rate and reason of urological surgery cancellation at a single academic institution, prospectively collected in our centre's Operating Room Scheduling Office System (ORSOS) database. Documented reasons for cancellations were divided into 3 components: (1) structural factors (e.g., no hospital bed); (2) patient factors (e.g., patient unwell); and (3) process factors (e.g., scheduling error). Rates and reasons for cancellations were compared to those of General Surgery and Gynecology. The documented reasons for cancellation in the ORSOS database were confirmed or extended by chart review and interviews with a subset of cancelled patients. Results: Between 2005 and 2009, 1544 out of 19 141 (8.07 %) elective surgical cases were cancelled within the three surgical specialties (general surgery, gynecology and urology); urology had the highest average rate of 9.53%. Non-oncological cases represented a higher percentage of cancelled cases (15%, p < 0.001) and overall rates varied significantly over time in urology compared to the other surgical specialties. Potentially modifiable, processrelated causes were by far the most common reason for cancellation (58.5%) and "standby" cases were a common cause of overall cancellation rates. Patient interviews confirmed the emotional and financial impact of cancellation; there was no overwhelming concern that clinical outcomes were negatively affected. Conclusions: This contemporary exploration of cancelled urological cases is consistent with previous reports, although variable over time and dependent on definitions used. Potentially modifiable, process-related factors appear to be most frequently associated with cancellation, although more thorough and detailed documentation is required to further mitigate inefficient OR use. We suggest that all OR cancellations should be considered to be adverse incidents to be monitored by institutions in a systematic fashion.

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The Effect of Hospital Size and Surgical Service on Case Cancellation in Elective Surgery

Abstract: When benchmarking cancellation rates among hospitals, comparisons should control for academic institutions having higher incidences of case cancellation than nonacademic hospitals and general surgery services having higher incidences than other services.

Cited by 91 publications

References 19 publications

Cancellation of elective surgeries in a Brazilian public hospital: reasons and estimated reduction

Cancellation of elective surgeries in a Brazilian public hospital: reasons and estimated reduction

Day of Surgery Cancellation in Urology at a Public Tertiary Hospital and a Private Specialist Hospital

Day of surgery cancellation rates in urology: identification of modifiable factors

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