The Anaesthetic Pre-Admission Clinic is Effective in Minimising Surgical Cancellation Rates.

Abstract

Pre-admission clinics (PAC) are now well-established in most hospitals. However, there have been few studies examining the efficacy of PACs in minimising day of surgery cancellations due to anaesthetic reasons. A retrospective cross-sectional descriptive study was carried out in a metropolitan tertiary hospital over a four-year period to assess reasons for anaesthetic-related day of surgery cancellations in elective surgical patients who attended the PAC. Of 12,537 patients who attended the PAC during the study period, 58 (0.46%) were cancelled on the day of surgery for anaesthetic reasons. The most common cause was non-preventable misadventure such as acute respiratory tract infections, seen in 19 patients (33% of all anaesthetic cancellations). The next most common cause was classified as being due to patient or system error (16 patients). This included patients' failure to adhere to fasting or medication guidelines, or a failure to detect and respond to abnormal laboratory results. Clinical disagreement between anaesthetic assessment at the PAC and the attending anaesthetist on the day of surgery was low (12 patients, 21%), and clinical deterioration in a pre-existing condition (six patients, 10%) accounted for the majority of other cancellations. Although patient misadventure constituted the major cause of anaesthetic cancellations, non-adherence to fasting and medication guidelines constituted the next major reason for surgery cancellation due to anaesthetic causes. This is important as such cancellations are potentially preventable and the overall cancellation rate could potentially be improved by instituting relatively simple changes to clinic function.