Reduction of same-day inpatient surgical cancellations with preoperative risk stratification

Abstract

BackgroundThe role of preoperative clinics in improving surgical outcomes, reducing rate of surgical delays and case cancellations for patients undergoing outpatient elective surgery is well established. However, the impact of preoperative evaluation and risk assessment of inpatients undergoing surgery is less clear. We hypothesized that utilizing a standardized risk stratification method could reduce the rate of Same-Day Inpatient Cancellations (SDICs) in patients undergoing inpatient surgery. MethodsThis was a single center study conducted at an academic tertiary care hospital. An inpatient surgery form (ISF) that included a “risk stratification matrix” was completed for all inpatients undergoing non-emergent surgery. ISF was implemented at our institution over a three-year period (July 2014- March 2017). ISF stratified patients into “low,” “intermediate,” and “high” risk groups, which prompted hospitalist and anesthesia consultations based on the patient's risk category. We evaluated the difference in median SDIC rates during the four phases and differences in median proportions of SDICs attributable to Medical Related cancellations (MRCs) and Process-related cancellations (PRCs). ResultsOf 17,177 inpatient cases included for analysis, the average SDIC rate over the study was 9.5%. The Post-ISF SDIC rate was significantly less than the Pre-ISF SDIC rate (8.0% vs. 9.7%, p = 0.004). The proportion of MRCs during Post-ISF was also less than the Pre-ISF proportion of MRCs (47.1% vs. 60%, p = 0.02). ConclusionStandardized approach to preoperative risk stratification combined with timely pre-operative assessment and medical optimization of inpatients requiring surgery reduces the overall rate of inpatient surgical case cancellations.