Assessing the Rates and Reasons of Elective Surgical Cancellations on the Day of Surgery: A Multicentre Study from Urban Indian Hospitals

Bhakti Sarang,Ashwani Kumar,Dhruva Ghosh,Kamal Kishore Gautam,Ya Dev,Akshay Bahadur,Geetu Bhandoria,Anita Gadgil,Rohini Dutta,Manisha Aggarwal,Kavita Mandrelle,Monty Khajanchi,Priyansh Shah,Priti Patil,Lovenish Bains,Prashant Bhandarkar,Lileswar Kaman,Neil Thivalapill,Deepa Kizhakke Veetil,Sunil Krishna,Nobhojit Roy

doi:10.1007/s00268-021-06364-1

Abstract

BackgroundCancellations of elective surgeries on the day of surgery (DOS) can lead to added financial burden and wastage of resources for healthcare facilities; as well as social and emotional problems to patients. These cancellations act as barriers to delivering efficient surgical services. Optimal utilisation of the available resources is necessary for resource-constrained low-and-middle-income countries (LMIC). This study investigates the rate and causes of cancellations of elective surgeries on the DOS in various surgical departments across ten hospitals in India.MethodsA research consortium ‘IndSurg’ led by World Health Organisation Collaboration Centre (WHOCC) for Research in Surgical Care Delivery in LMICs, India conducted this multicentre retrospective cross-sectional study to analyse the cancellations of elective/planned surgical operations on DOS across urban secondary and tertiary level hospitals. We audited surgical records of a pre-decided period of six weeks for cancellations, documented relevant demographic information and reasons for cancellations.ResultsWe analysed records from the participating hospitals, with an overall cancellation rate of 9.7% (508/5231) on the DOS for elective surgical operations. Of these, 74% were avoidable cancellations. A majority (30%) of these 508 cancellations were attributed to insufficient resources, 28% due to patient's refusal or failure to show-up, and 22% due to change in patient's medical status.ConclusionWe saw a preponderance of avoidable reasons for elective surgery cancellations. A multidisciplinary approach with adequate preoperative patient counselling, timely communication between the patients and caregivers, adequate preoperative anaesthetic assessment, and planning by the surgical team may help reduce the cancellation rate.

Highlights

Efficient delivery of surgical services is a key performance indicator of healthcare establishments
Optimal utilisation of the available resources is necessary for resource-constrained low-and-middle-income countries (LMIC)
508 surgeries were cancelled on the day of surgery (DOS), with an overall rate of surgery cancellations of 9.7%

Summary

Introduction

Efficient delivery of surgical services is a key performance indicator of healthcare establishments. Elective surgery cancellations on the ‘day of surgery’ (DOS) may result from inadequate preoperative patient evaluation, inefficient patient counselling and organisational, administrative and operating room fallacies These cancellations are an indirect indicator of patient care quality and a marker to assess the hospital management systems [1, 2]. A West African study from Burkina Faso estimated an additional cost of 19 thousand dollars incurred over three months by the hospital, with a mean value of 80 dollars per patient due to surgery cancellations [5] Such a substantial economic impact on the healthcare systems necessitates efforts towards identifying the various factors related to such cancellations. Cancellations of elective surgeries on the day of surgery (DOS) can lead to added financial burden and wastage of resources for healthcare facilities; as well as social and emotional problems to patients These cancellations act as barriers to delivering efficient surgical services. We audited surgical records of a pre-decided period of six weeks for cancellations, documented relevant demographic information and reasons for cancellations

Methods

Results

Discussion

Conclusion