Hypertension as a reason for cancellation of elective surgical cases on day of surgery: A five year audit report from The Aga Khan University Hospital Karachi.

Abdul Monem,Amjad Nadeem,Fauzia Khan

doi:10.5455/jpma.282318

Abstract

To assess the controllable factors in preventing undue cancellation of elective surgical cases and to suggest measures to address the issue. The retrospective audit was conducted at the Aga Khan University Hospital, Karachi, and comprised all cancellations of elective surgery from 2011 to 2015. The cases reviewed had been cancelled primarily due to hypertension. A three-member committee regularly reviewed files regarding case cancellations and data was gathered. Of the 42,242 surgical cases scheduled during the period, 2903 (6.8%) were cancelled. In 11(0.37%) of these cases, hypertension was the primary reason. Of them, 10(91%) were men and 1(9%) woman. Overall age range was 30-77 years. Among the cancelled cases, 3(27.3%) each belonged to neurosurgery and general surgery, 2(18%) each to orthopaedic and urology, and 1(9%) to ear, nose and throat surgery. Hypertension as the primary reason for cancellation was low. Further reductions in these cancellations can be done by emphasis on following guidelines and their dissemination through continuing medical education.

Highlights

Cancellation of elective surgical cases after hospital admission causes emotional distress for patients and their families and resource wastage for hospital.Uncontrolled hypertension is a common reason for such cancellations
A survey of South Asian immigrant workers in the United Arab Emirates from Pakistan, India and Bangladesh revealed an overall incidence of 30.4%,8 and 76% of them were unaware of the disease
As per the standard operating procedure (SOP) at AKUH, if any elective surgical case is cancelled, patient data and the reason for cancellation are entered on a designated form

Summary

Introduction

Cancellation of elective surgical cases after hospital admission causes emotional distress for patients and their families and resource wastage for hospital. Uncontrolled hypertension is a common reason for such cancellations. Cancellation rates have been reported as 3.5%,1 13.4%2 and 39.8%3 in different studies. The World Hypertension Society / International Society of Hypertension (WHO/ISH) reported the incidence of hypertension as 60% in adults[4] which increases with age.[5] Jaffer et al[6] reported an incidence of 25% in Pakistani population. A prevalence study from South Asian Association for Regional Cooperation (SAARC) reported a 13% to 48% incidence of hypertension.[7] A survey of South Asian immigrant workers in the United Arab Emirates from Pakistan, India and Bangladesh revealed an overall incidence of 30.4%,8 and 76% of them were unaware of the disease. The current study was planned to identify cases where hypertension was mentioned as the primary reason for the cancellation of surgery, and to see how such cancellations can be reduced

Material and Method

Results

Discussion

Conclusion