Cancellation of Scheduled Surgery at a Tertiary Hospital in Sub-Saharan Africa: A Barrier to Access to Surgical Care

Abstract

Provision of surgical care is essential to health care worldwide. Cancellation of scheduled surgical cases compromises the quality of surgical services, potentially causing an increase in emergent case volume and patient harm. Cancellation occurs due to health care system-, provider-, and patient-related factors. We sought to evaluate the volume of scheduled surgery cancellation and the associated reasons for cancellation at a tertiary care center in Malawi. This is a retrospective review of the Department of Anesthesiology administrative data from August 8, 2011 to January 9, 2015, at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi. Data included weekday records of number of scheduled surgeries, number of cancelled operations, and reasons for cancellation. Descriptive statistics were performed. Of 10,730 scheduled procedures, 4,740 (44.2%) were cancelled. The most common reason for cancellation was infrastructural limitations (50.9%), including time constraints (33.3%) and equipment shortages (17.7%). Provider limitations accounted for 11.8% of cancellations, most often due to shortages of anesthesia providers. Inadequate preoperative medical care led to 23.7% of cancellations. This study demonstrates a high scheduled-case cancellation rate at a tertiary care center in Malawi, attributable primarily to infrastructural limitations. This provides further evidence that investments in healthcare infrastructure and optimization of surgical workforce are critical to improving access to surgical services in this region.