Cancellation Of Surgical Cases Research Articles

Pediatric influenza vaccination in the perioperative setting: A quality improvement project.

Unmet need for seasonal influenza vaccination administration to pediatric patients exists at national and local levels. Vaccination during the perioperative period remains controversial, though opportunity exists to meet vaccination need through perioperative programs. The initial SMART Aim of this quality improvement initiative was to establish and increase seasonal influenza vaccination rate in eligible patients during in person preoperative clinic visits in a pediatric perioperative surgical home (PSH) to 10%. Informed by each prior season's experience, we increased our SMART Aim target for vaccinations in seasons two and three to 15 and 18%, respectively. Following the Model for Improvement methodology, the PSH team developed and implemented a perioperative pediatric influenza vaccination program. Across three influenza seasons, key interventions included updates to organizational perioperative vaccination policy, obtaining material influenza vaccination supplies, development of EHR tools, PSH staff education, and communication with patient-families. Rate of eligible patients receiving influenza vaccination at their PSH clinic appointment was tracked over time. Influenza vaccination rates were reported monthly during Season 1, then weekly during seasons two and three. The balancing measure was same day surgery case cancellations related to influenza vaccination given at PSH clinic appointment. Statistical analysis methods utilized include Shewart's control chart and statistical process control (SPC) standards. Special cause variation was determined by eight or more consecutive data points above or below the centerline. The influenza vaccination rates in each of the three influenza seasons exceeded vaccination rate goals of 10, 15, and 18%, respectively. A total of 695 vaccines have been administered since program inception. No same day surgical case cancellations were observed as balancing measure. Over three consecutive influenza vaccination seasons, we safely established and met vaccination rate goals of 10, 15, and 18% to eligible patients during preoperative clinic visits within a pediatric PSH system. Through iterative PDSA cycles, we continue to identify opportunities for future improvement. This suggests that the perioperative period presents opportunity for seasonal influenza vaccination with potential program expansion to include routine vaccines of childhood.

A Feasibility Study on a Telemedicine Hybrid Protocol for Preoperative Anesthetic Assessment.

Background Over the past decade, telemedicine has experienced significant growth due to technological advancement, and the coronavirus disease 2019 (COVID-19) pandemic further accelerated its adoption. However, the field of anesthesiology has been slow in integrating and embracing telemedicine compared to other medical specialties. Methods We conducted an observational pilot feasibility study at a tertiary hospital in Singapore to assess the viability of a telemedicine hybrid protocol for preoperative anesthetic assessment. The study included patients aged 21 to 65 years, classified as American Society of Anesthesiology (ASA) physical status class 1 or 2, with a body mass index (BMI) below 35 kg/m2, who were capable of managing video conferencing. The patients selected were scheduled for low-risk surgeries. The primary objective was to evaluate the medical and technical feasibility of our telemedicine hybrid protocol, while the secondary objectives included assessing patient satisfaction and obtaining feedback from relevant stakeholders. Results From November 2021 to April 2022, a total of 116 patients were recruited, with 96 patients completing the study. No technical difficulties, surgical case cancellations, or incidents of unanticipated difficult airways were reported. The majority of survey respondents (88%) expressed satisfaction with the video consultation and indicated a preference for it over physical consultations for future preoperative anesthesia evaluations. Conclusion Based on our findings, a telemedicine hybrid protocol for preoperative anesthetic assessment demonstrated both technical and medical feasibility while yielding high patient satisfaction. Future research could focus on expanding the protocol to encompass more complex surgeries and include patients with higher ASA status.

The Golden Patient Initiative: A Systematic Review.

Operating theatres and surgical resource consumption comprise a significant proportion ofhealthcare costs. Inefficiencies in theatre lists remain an important focus for cost management, along with reducing patient morbidity and mortality. With the emergence of the coronavirus disease 2019 (COVID-19) pandemic, the number of patients on theatre waiting lists has surged. Hence, there is a pressing need to utilise the already limited theatre time and fraught resources with innovative methods. In this systematic review, we discuss the Golden Patient Initiative (GPI), in which the first patient on the operating list is pre-assessed the day prior to surgery, and we aim to assess its impact and overall efficacy. A literature search using the following four databases was conducted to identify and select all clinical research concerning the GPI: Medical Literature Analysis and Retrieval System Online (MEDLINE),Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (EMBASE), and the Cochrane library. Two independent authors screened articles against the eligibility criteria, using a process adapted from the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Data extracted included outcomes measured, follow-up period, and study design. The results showed significant heterogeneity, and hence a narrative review was conducted; 13 of the 73 eligible articles were included for analysis. Outcomes included delay in theatre start time, number of surgical case cancellations, and changes to total case numbers. Across the studies, a 19-30-minute improvement in theatre start time was reported (p<0.05), as well as a statistically significant decrease in case cancellations. Our analysis provides encouraging conclusions with regard to greater theatre efficiency following the application of GPI, a low-cost solution that can easily be implemented to help improve patient safety and lead to cost savings. However, at present, it is largely implemented amonglocal trusts, and hence larger multi-centre studies are required to gather conclusive evidence about the efficacy of the initiative.

Prevalence and Causes of Elective Surgical Cancellations: Findings from a Rural Tertiary Hospital in the Eastern Cape, South Africa.

Background: Cancellations of elective surgeries adversely affect the patient, hospital staff, facility, and health system. Cancellations potentially result in hospital financial losses, theatre inefficiency, and substandard patient care. A common benchmark for the cancellation rate of elective surgeries is less than five percent, and most operating rooms fall short of this standard. There is a paucity of data on the rates and causes of elective surgical cancellations in rural, resource-limited settings. This study aimed to determine the prevalence of elective surgery cancellations, the causes for such cancellations, and the surgical disciplines most affected at Nelson Mandela Academic Hospital (NMAH). Methodology: This was an observational, descriptive, cross-sectional review of operating theatre records from January 2019 to July 2019. The prevalence and main causes of elective case cancellations were determined. The causes were classified, and the most affected surgical departments and patient characteristics were identified. Results: The prevalence of elective surgical case cancellations was 14.4% in our hospital, higher than the international benchmark of 5%. Patient-, facility-, and surgical-related factors were the leading causes of cancellations, and avoidable cancellations were mostly surgical- and anaesthetic-related. Ophthalmology was the most affected, followed by gynaecology and general surgery, with plastic surgery being the least affected. The most common patient-related factors were nonattendance and uncontrolled medical conditions, while overbooking was the most common surgical reason. Abnormal investigatory results and unfit status were the most common anaesthetic reasons. Facility-related issues included the lack of theatre time, equipment scarcity or malfunction, and staff unavailability. Most cancellations were unavoidable, but with careful planning, could be avoided. Conclusion and recommendations: This study identified challenges with theatre efficiency in a rural, resource-limited setting that call for the cooperation of multidisciplinary teams of surgeons, anaesthetists, nursing staff, and health care policymakers.

The Impact of Sterile Instrument Set Wrapping Defects on Trauma and Orthopaedic Surgery Theatre Lists.

Introduction Surgical site infections (SSIs) are a universally dreaded complication of any surgical procedure. The goal of this single-center study was to examine the issue of orthopaedic instrument wrapping defects with a focus on the importance of a high level of surveillance to enable identification of these defects in order to reduce the risk of instrument contamination. We also evaluated the impact on patient care, theatre staff, hospital finances and resource utilization during a defined study period in order to stimulate critical discussion and further research into potentially eliminating this problem via change in practice and advances in technology. To the best of our knowledge, this will be the first paper that looks at this problem from the above perspective within the United Kingdom National Health Service. Methods We conducted a prospective service evaluation project over a 30-week period from December 2021 to July 2022 across our three hospital sites within the United Kingdom National Health Service.We collated data on defects found in orthopaedic instrument wrappings as detected by visual inspection under ambient or theater lighting and the resulting surgical case cancellations. Defect types included in the study were all puncture holes, abrasions or tears visible to the naked eye irrespective of their size. Results A total of 601 orthopaedic sets were rejected during the study period due to defects identified in the sterile instrument wrappings. Of these, 437 were due to holes/tears in the wrapping, 129 were due to wet inner wrappings and 35 were due to insecure wrappings. This directly resulted in same-day cancellation of 13 surgical cases or 0.27% of booked cases with extra sets required for the other affected cases. These 13 cases could not proceed as they involved loan kits where no remedial action could be taken. Remedial action was required for the other 588 operation list cases affected by the sterile wrapping defects. The majority of the identified defects and resulting theatre case cancellations (61.5%) were in hip and knee arthroplasty surgery. The calculated potential financial loss due to these problems was £145,000 over the seven-month study period. This financial cost is equivalent to the best practice top-up tariff in England for treating approximately 108 hip fracture patientsbased on £1,335 per patient. Conclusion Our study identified defects in the sterile instrument wrappings affecting both the inner with or without involving theouter wrapping layerand resulting in cancellation of elective and trauma orthopaedic cases with resultant clinical and financial implications. There is a need to be more vigilant in identifying defects in drapes. Further research is warranted to improve ways of identifying defects in sterile wrappings and devise new protective mechanisms during sterilisation that can eliminate the use of sterile instrument wrappings.

P09 The golden patient initiative: a systematic review

Abstract Introduction Operating theatres and surgical resource consumption comprise a significant proportion of all healthcare costs. Inefficiencies in theatre lists remain an important focus for cost management. During COVID-19 pandemic, the number of patients on theatre waiting lists has surged. Hence there is a pressing need to utilise already limited theatre time and fraught resources with innovative methods. In this systematic review we consider the Golden Patient Initiative (GPI), in which the first patient on the operating list is pre-assessed the day prior to surgery, and we aimed to assess its overall efficacy. Methods A literature search using four databases: MEDLINE, CINAHL, EMBASE, and the Cochrane library identified all clinical research concerning the GPI. Two independent authors screened articles against eligibility criteria, using a process adapted from PRISMA guidelines. Data extracted included outcomes measured, follow-up period and study design. The result displayed significant heterogeneity; therefore a narrative review was conducted. Results 13 of 73 eligible articles were included for analysis. Outcomes included delay in theatre start time, number of surgical case cancellations and changes to total case numbers. Across the studies, a 19–30 minute improvement of theatre start time was reported (P&amp;lt;0.05), as was a statistically significant decrease in case cancellations. Conclusion Our analysis gives encouraging conclusions for theatre efficiency with the GPI, a low cost solution which can easily be implemented to help improve patient safety lead to cost savings. However, at present it is largely implemented amongst local trusts, hence larger multicentre studies are required to provide conclusive evidence. Take-home message Our analysis gives encouraging conclusions for greater theatre efficiency with the GPI, a low cost solution which can easily be implemented to help improve patient safety lead to cost savings.

Contributing Factors of Elective Surgical Case Cancellation: A Cross- Sectional Descriptive Study

Introduction: Elective surgical case cancellation refers to a scheduled surgical procedure that not performed on a given day. Cancellation of elective surgical operation recognized as a major cause of emotional trauma to patients as well as their families. It has been a long-standing problem for healthcare organizations across the world. Methods: This was a cross-sectional observational study conducted from September 01 to November 30, 2021 for a period of three months in a 750-bedded tertiary care hospital, Kathmandu. A cancelled procedure was defined as a patient’s name appearing on the list for surgical operations but the operation not being performed on the scheduled date. Patients scheduled for surgical procedures were recruited into this study by the principal investigator and research assistants on the day prior to their operation. Results: Of total 600 patients scheduled for elective procedures over a period of three months, the prevalence of cancellation of elective surgical procedures was found to be 15.33 % (n=92). Of the examined surgical specialties, the cancellation prevalence was highest in GI and HPB at 40.9% (n =47), closely followed by Urosurgery at 31(33.6%), general surgery17(18.47%), plastics, Paediatric surgery 5(5.4%) and burn and plastics surgery 2 (2.1%) having the least cancellationrate at 2(2.1%) which was statistically significant (p value&lt;0.05). Conclusions:Inadequate preoperative preparation, prioritized emergency cases and equipment shortages are the common causes of elective surgical cancellations.

INCIDENCE OF CANCELLATIONS OF ELECTIVE OPERATIONS ON THE INTENDED DAY OF SURGERY AT A SUPER SPECIALITY HOSPITAL AND THEIR REASONS: A RETROSPECTIVE ANALYSIS

Background: Any elective surgical case that is scheduled on the OT list on the day prior to surgery but not operated upon as scheduled can be regarded as an elective surgical case cancellation. Case cancellation is considered a major cause of wastage of material and human resources in the hospital and has a major impact of psychological setback to patients together with their families as well. Reasons for cancellations are quite complex and vary from hospital to hospital because they are correlated to patients in that area, management of hospital, organizational issues, and other hospital and OR staff. Methods: Among 1600 participants, a retrospective hospital-based, cross-sectional study was carried out in a super speciality hospital. A selfadministered questionnaire with an observatory checklist was used for collecting and assorting data from the OR managers, case related anaesthetists, nurses, and surgeons. Results: In this study, 1600 patients were scheduled for elective surgical operations. Among those, nearly almost one-sixth 259 (16.19%) of the operations were cancelled and 1341 (83.81%) patients were operated on their planned date. The reasons for cancellation were patient related (65.3%), anaesthesia related (10%), management related (9.3%) and rest were surgeon related factors (1.2%). The cancellations happened mainly due to improper scheduling (14.3%) which were rescheduled at some other time, unavailability of surgeons (1.1%), unavailability of oxygen and blood (1.1%) and equipment (0.7%). Department wise if the study was viewed at, General surgery (27%) urology (20.8%) and orthopaedics (15.1%) were the commonest cancelled cases. Conclusion: The cancellation rate at our medical centre remains relatively low. Patient related causes, medical illness, and management related causes were the commonest reason for the cancellation of elective operations.

Cancellation of Elective Surgeries in A Tertiary Care Hospital in North India

Background: Cancellation of elective surgical treatments is a quality-of-care issue as well as a huge waste of health-care resources. Patients may experience emotional distress as a result of this, as well as difficulty for their families. Aim: To find the significant reasons of cancellation of scheduled surgical cases.&#x0D; Methods: A total of 300 elective operations in our institution were chosen. The completed surgeries were planned on the scheduled operation day, and the anaesthesiologist noted down a list of cancellations along with their reasons.&#x0D; Results: A total of 300 patients were scheduled for surgery. A total of 60 patients were cancelled, resulting in a 20% cancellation rate. Lack of operational time was the most prevalent reason for cancellation.&#x0D; Conclusion: The majority of the reasons for cancellation should have been avoided with proper list preparation and the surgical team's meticulous planning.

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

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.

Implementation of evidence-based recommendations to reduce elective surgical case cancellations

BackgroundCancellation of elective surgical cases leads to a waste of resources, financial burden, patient dissatisfaction, extended hospital stay, and unnecessary repetition of preoperative preparations. AimThe objective of this study was to identify, analyze and manage the causes of cancellation of elective surgical cases in our institution. MethodsThis quality improvement study compared preoperative cardiovascular event and case cancellation rates before and after implementing the practice of perioperative cardiovascular risk management. The study included the following phases: (1) Screening and identification of the most important reason for case cancellation; (2) Developing the strategy and internal protocol based on the international recommendations to minimize perioperative cardiovascular risk; (3) Implementing the internal protocol and monitoring preoperative cardiovascular events and case cancellation rate. ResultsWe achieved a reduction in surgical case cancellation rate: 83 (3.7%) out of 2242 in 2018 and 28 (1.1%) out of 2538 cases in 2019 were cancelled after the patient had been delivered to the operating room area. ConclusionScreening and identification of gaps in perioperative care as well as implementation of evidence-based recommendations can significantly improve the quality of patient care. In our case, implementing the internal protocol of cardiovascular risk management in perioperative period resulted in a reduction of preoperative hypertensive crisis, myocardial ischemia, heart rhythm disorder rates and in subsequently reduction in case cancellation rate.

Root causes of elective surgical case cancellation in Ethiopia: a systematic review and meta-analysis

BackgroundCancellation of elective surgical operation recognized as a major cause of emotional trauma to patients as well as their families. In Ethiopia, prevalence and root causes for elective surgical case cancellation varies from time to time in different settings. This systematic review and meta-analysis aimed to find the pooled prevalence and root causes for elective surgical case cancellation in Ethiopia.MethodsThe databases for the search were Web of Science, PubMed, and Google Scholar. The last literature search was performed on February 8, 2020. To assess publication bias Egger’s regression analysis was applied. The pooled estimation was estimated using random-effects model meta-analysis. Subgroup analysis was also done based on the root causes of surgical case cancellation.ResultsThis meta-analysis included a total of 5 studies with 5591 study participants. The pooled prevalence of elective surgical case cancellation was 21.41% (95% CI: 12.75 to 30.06%).Administration-related reason (34.50%) was the most common identified root cause, followed by surgeon (25.29%), medical (13.90%), and patient-related reasons (13.34%).ConclusionThe prevalence of elective surgical case cancellation was considerable. The most common root cause for elective surgical case cancellation was administration-related reasons, followed by the surgeon, medical and patient-related reasons. The causes for the surgical cancellations are potentially preventable. Thus, efforts should be made to prevent unnecessary cancellations through careful planning.

The incidence and reasons for canceled surgical cases in an academic medical center: a retrospective analysis before and after the development of a preoperative anesthesia clinic.

The development of a preoperative anesthesia clinic (PAC) can reduce the number of surgical cases canceled on the day of surgery. However, there are only a few studies on the details of cancellations in the operating room. This study aimed to assess the incidence and reasons for surgical cases canceled from admission to the operating room to the start of surgery. This retrospective study involved patients who underwent anesthesia performed by anesthesiologists between January 2008 and March 2019. We focused on case cancellations occurring from admission to the operating room to the start of surgery. We classified the reasons for cancellation into four categories: insufficient preoperative anesthetic assessment, anesthetic issues/complications, medical problems related to patients' comorbidity, and others. We evaluated and compared the incidence and reasons for cancellation before and after the establishment of a PAC. Among a total of 48,089 scheduled surgery, 18 (0.037%, 95% confidence interval 0.019-0.055) cases were canceled. The total cancellation rate before and after the development of a PAC was not statistically significant (0.051% vs 0.022%, P = 0.10). Before the development of a PAC, the most common reason was insufficient preoperative anesthetic assessment in 46.1%, followed by anesthetic issues/complications (23.0%), medical problems related to patients' comorbidity (15.3%), and others (15.3%). After the development of a PAC, surgeries were canceled for medical problems related to patients' comorbidity (80.0%) and anesthetic issues/complications (20.0%). The total incidence of surgical case cancellations was 0.037%. Before and after the development of a PAC, cancellation rate was comparable. After the development of a PAC, none case were canceled due to insufficient preoperative anesthetic assessment.

COVID-19 and Orthopaedics: Recovery After the Pandemic Surge

The novel Coronavirus (COVID-19) pandemic has placed an immense strain on health care systems and orthopedic surgeons across the world. To limit the spread, federal and state governments mandated the cancellation of all nonurgent surgical cases to address surging hospital admissions and manage workforce and resource reallocation. During the pandemic surge, thousands of surgical cancellations have been required. We outline our experience through the onset and advance of the surge, detail our incident response and discuss the transition toward recovery. Level of Evidence: Level V

The re-planning and scheduling of surgical cases in the operating room department after block release time with resource rescheduling

The decisions on the strategic and tactical level contained in the operation room scheduling process are based on the expected demand. This demand is used to construct the master surgery schedule in a block booking system, which serves as a base for the planning and scheduling of surgical cases. However, in the operational phase, the actual demand may differ from the expected demand. This leads to increased waiting times, the cancellation of surgical cases and an inefficient utilisation of the operation room department for surgeons with spare capacity. In this paper, we study the Surgical Case re-Planning and Scheduling problem with resource re-scheduling that arises at block release time where the operation room planner tries to balance the capacity and the demand on the operational level. To that purpose, changes with respect to the surgeon schedule and the nurse roster are considered to adequately re-plan and schedule surgical cases. The problem under study minimises the number of changes related to the patient planning, the patient waiting time and the resource re-scheduling cost. We propose a three-phase heuristic that uses column generation to construct a high-quality feasible solution, which is further improved via local branching. Computational experiments have been conducted on an artificial dataset generated in a controlled and structured manner and on real-life data. Results demonstrate that our approach is able to produce (near-)optimal solutions and show the contribution of the different algorithmic building blocks.

Reducing Cancellations and Optimizing Surgical Scheduling of Ophthalmology Cases at a Veterans Affairs Medical Center.

Preventable causes of ophthalmology surgical case cancellations were identified, and interventions were implemented to improve operating room utilization at our Veterans Affairs (VA) Medical Center. A retrospective review of 269 patients with cancellations from 2013 to 2015 was performed. Interventions implemented from September 2014 to March 2015 were evaluated followed by in-depth chart reviews to identify demographics and wait-time intervals. Interventions included scheduling surgeries electronically, by specialty, and with predetermined attending coverage. In addition, the preoperative templates and technology to obtain preoperative measurements were updated. Cancellation rates dropped significantly from 35% to 7% (p = .014). Preventable causes of cancellations decreased from 28% to 5% (p = .005). Operating room utilization increased significantly with 264 more scheduled cases in 2015 than in 2013 (485 vs. 749, p < .001), and surgery wait time trended downward. These findings may support the use of similar interventions at other VA medical centers or similar hospitals with the goal of improving quality of care through decreased cancellations and cost.

Incidence and causes of cancellations of elective operation on the intended day of surgery at a tertiary referral academic medical center in Ethiopia

BackgroundElective surgical case cancellation refers to any elective surgical case that is the list on the day prior to surgery but not operated upon as scheduled. Case cancellation has a major cause of psychological trauma to patients and their families. Despite little is known in Ethiopia. Therefore, this study aimed to assess incidence and reasons of cancellations of elective operation on the intended day of surgery at tertiary referral academic medical center in Ethiopia.MethodsA prospective hospital-based cross-sectional study design was conducted in a tertiary referral academic medical center in Ethiopia among 146 participants. A self-administered questionnaire with an observatory checklist was used for collecting data from the anesthetist, nurse, and surgeons.ResultIn this study, 462 patients were scheduled for elective surgical operations. Among those, nearly almost one-third 146 (31.6%) of the operations were cancelled and 316 (68.4%) patients were operated on their planned date. The most common reason for cancellation were surgeon related (35.8%), patient related (28.7%), management related (21.2%) and anesthesia related factors (14. 4%). The cancellation was mainly due to improper scheduling (20.5%%), unavailability of surgeons (8.9%), unavailability of oxygen and blood (8%) and equipment (5.5%). Orthopedic (28.8%) and general surgery (17.1%) were the commonest cancelled cases.ConclusionThe cancellation rate in our academic medical center remains high. Improper scheduling, unavailability of surgeons, medical illness, and unavailability of operating room equipment were the commonest reason for the cancellation of elective operation. Most cancellations were preventable. For this, proper preoperative assessment, proper scheduling, fulfilling necessary operating room equipment’s and cross-matched blood by the hospital and other stakeholders, early clear communication with operating room team like surgeons was recommended.

Enfrentando el dilema de las suspensiones: características e incidencia de las suspensiones quirúrgicas en un centro académico en Chile

Introduction: Surgical cancellations are a complex problem in the field of Operating Room Management, affecting patients, staff, including surgeons and anesthetists, and compromising the finances of health institutions. The available information about the incidence and characteristics of surgical cancellations in our country are scarce. Objective: The aim of this article is to characterize the surgical cancellations in a Chilean academic center, describing its global incidence and by specialty. Materials and Methods: Prospective information on surgical schedule and Operating Room activity was included in this cohort study of surgical case cancellations occurring from January 1, 2016 through May 20, 2017. To calculate the percentage of cancellations, 3 groups were used based on 6 periods of 4 weeks. The Freeman-Turkey double-arcsine transformation and Student’s t-test were applied. Results: During the study period, 11,398 surgeries were programmed, of which 492 were cancelled. The incidence of cancellations for the 3 periods was 4.38% (95% CI 3.78% to 5.01%), 4.15% (95% CI 3.51% to 4.85%) and 4.10% (95% CI of 3.50% to 4.74%) respectively. In at least 57% of cases the main identifiable cause of cancellation was a change in the patient’s medical condition. Discussion and Conclusions: Our results consistently show that the cancellation rates range between 3% and 5%, which is within international standards, and can be used as benchmarking for comparisons at a national level.

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

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.

Contributing factors of elective surgical case cancellation: a retrospective cross-sectional study at a single-site hospital

BackgroundCase cancellation (CC) has significant impact on the efficiency of operating room (OR) management, which can be mitigated by taking preventive measures. In this study, using the data of the West China Hospital (WCH), we identified the effect of contributing factors and recommended hospital interventions to facilitate CC prevention.MethodWe conducted a retrospective review of 11,331 elective surgical cases from January 1 to December 31, 2014. CC reasons were grouped into six categories. The methods of descriptive statistics and hypothesis test were used to identify the effect of factors.ResultsCC reasons (746) were divided into six broad categories: workup related (preoperative diagnostic assessment issues or sudden medical condition changes) (25.8%), non-specified reasons (25.8%), coordination issues (15.1%), patient related (13.0%), support system issues (11.8%), and doctor related (8.5%). The types of the most frequently performed operations are identified, as well as their CRs. The cancellation rate (CR) of males was lower than that of females (16.7% to 18.3%). A large difference in the CRs existed among doctors. The CR on Monday was significantly higher than the other four weekdays.ConclusionsWorkup related issues, the types of procedures, the menstrual cycle of females, highly imbalanced CRs among doctors, and tendency of cancellation on Monday are the major identified factors, which account for a significant amount of preventable cancellations. It is suggested that corresponding hospital interventions can reduce CR and improve OR efficiency, including maintaining effective coordination, good communication and well-designed preoperative assessment processes, focusing on the type of procedures which are more time-consuming and complex, paying special attention to the physiology of females during surgery planning, taking measures to reduce CR of top eight doctors, and improving surgery scheduling on Monday.