Elective Surgical Case Cancellation Research Articles

908 Factors Affecting Last Minute Cancellation of Elective General Surgical Cases; Preliminary Findings of a QIP

Abstract Introduction Waiting lists for elective general surgeries have been growing steadily over the past few years, with short-notice cancellations affecting both cost and patient safety. There are currently nationwide incentives to cut referral-to-theatre delays and tackle the backlog of over 7 million patients (NHS backlog data analysis - British Medical Association 2022). Aim To identify common causes of short-notice cancellation of elective general surgery lists, and identify targets for intervention for minimisation. Method This audit was registered with the department. Prospectively collected elective general surgery lists between January and November 2022 were compiled and analysed. We coded the reason for cancellation from patient records. For the patients found to be unfit on the day to come in (TCI), we reviewed PAC notes to see whether they had been deemed fit at PAC and how this had changed. Data were coded and analysed on Microsoft Excel on secure Trust computers. Results Between 01/01/2022 and 06/11/2022, 508 (22%) of the scheduled 2300 cases were cancelled, with 235 (10.2%) within 48 hours of their scheduled start date. Acute patient illness and patient unavailability were the most common causes of short notice cancellation of a case (n = 41), followed by time constraints (n = 33), patients not being medically optimised (n = 27) or no longer requiring surgery (n = 21, as well as administrative error (n = 14). Conclusions Targets for intervention following these preliminary audit results included improved patient literature at pre-assessment, clerical chart review in the lead up to the surgery to ensure all administrative tasks have been performed, and a clinical review immediately prior the TCI date to identify any intercurrent illness.

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<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.

157. Worsening pain and quality of life for spine surgery patients during the COVID-19 pandemic: roles of psychological distress and patient activation

157. Worsening pain and quality of life for spine surgery patients during the COVID-19 pandemic: roles of psychological distress and patient activation

Examining the impact of COVID-19 restrictions on the operative volumes of US general surgery residents

BackgroundIn March 2020, the COVID-19 virus global pandemic forced healthcare systems to institute regulations including the cancellation of elective surgical cases, which likely decreased resident operative experience. The objective of this study was to determine whether the COVID-19 pandemic affected operative experiences of US general surgery residents. MethodsThe operative experience of general surgery residents was examined nationally and locally. Aggregate Accreditation Council for Graduate Medical Education (ACGME) case logs for 2018 to 2019 (pre-COVID) and 2019 to 2020 (COVID) graduates were compared using national mean cumulative operative volume for total major and surgeon chief cases. Locally, ACGME case logs were used to analyze the operative experience among residents at a single, academic center. Average operative volumes per month per resident during peak COVID-19 quarantine months were compared with those the previous year. ResultsCompared with 2019 graduates, 2020 graduates completed 1.5% fewer total major cases (1055 ± 155 vs 1071 ± 150, P = .011). This was most evident during chief year, with 8.4% fewer surgeon chief cases logged in 2020 compared with 2019 (264 ± 67 vs 289 ± 69, P < .001). Institutional data revealed that during the peak of the pandemic, residents across all levels completed 42.5% fewer total major operations (12 ± 11 vs 20 ± 14, P < .001). This effect was more pronounced among junior residents compared with senior and chief residents. ConclusionThe COVID-19 pandemic was associated with decreased resident case volume. The ramifications of the COVID-19 pandemic for operative competency and autonomy should be carefully examined.

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.

Reasons and appropriate measures to circumvent cancellation of elective surgical cases: A clinical audit of a government teaching hospital

Background: Cancellation of elective surgical cases is a major unresolved problem for health care organizations worldwide and also a parameter for assessing the quality of both the patient care and management system. In the present study, we retrospectively investigated the cancellation rates and reasons for the same in a government teaching hospital and suggested measures to circumvent such cancellations.Materials & Methods: Medical records of 1207 patients, whose elective surgical procedures were cancelled on the day of surgery between June 2015 and May 2017, from all surgical specialties of the hospital, were retrospectively audited. The reasons for cancellation were noted.Results: Of the 7316 cases scheduled for elective surgeries between June 2015 and May 2017; 1207 (16.49%) cases were cancelled on the day of surgery. The highest number of cancellations occurred in the specialty of orthopaedics (6.84%) followed by general surgery (5.41%). Both otorhinolaryngology (2.06%) and gynaecology (2.07%) exhibited similar cancellation rates whereas facio-maxillary surgery exhibited the lowest cancellation rate (0.09%). The main reason for cancellation was the unfit condition of patients for surgeries because of medical reasons [599 (49.6%)], followed by Inadequate operation theatre time [274(22.7%)], equipment failure [207(17.2%)] and patients not turning up for procedures [127(10.5%)].Conclusion: Cancellation rates and reasons for cancellation vary across institutions. Regular prospective or retrospective clinical audits improve quality of health services, whereas control charts help in enhancing the overall picture and monitoring the reasons for cancellation. Most of the cancellations are avoidable.

Prevalence and factors associated with cancellation and deferment of elective surgical cases at a rural private tertiary hospital in Western Uganda: a cross sectional study

Introductionthe cancellation of elective surgery is still a worldwide challenge and this is associated with emotional and economical trauma for the patients and their families as well as a decrease in the efficiency of the operating theatre. This study aimed at determining the prevalence and factors associated with cancellation and deferment of elective surgery in a rural private tertiary teaching hospital in Western Uganda.Methodsa cross-sectional study design was conducted. Data was collected from 1st July 2019 to 31st December 2019. Patients scheduled for elective surgery and either cancelled or deferred on the actual day of surgery were included in the study. Statistical analysis was done using STATA version 15.Resultsfour hundred patients were scheduled for elective surgery during the study period, among which 90 (22.5%) were cancelled and 310 (78.5%) had their surgeries as scheduled. The highest cancellation of elective surgical operations was observed in general surgery department with 81% elective cases cancelled or deferred, followed by orthopedic department 10% and gynecology department 9%. The most common reasons for cancellation were patient-related (39%) and health worker-related (35%) factors. Other factors included administrative (17%) and anesthesia related factors (9%). Cancellation was mainly due to lack of finances which accounted for 23.3% of the patients, inadequate patient preparation (16.6%) and unavailability of surgeons (15.5%). Major elective surgeries were cancelled 1.7 times more than minor electives surgeries [adjusted prevalence ratio 1.7 (95%CI: 1.07-2.73) and p-value: 0.024].Conclusioncancellation and deferment of elective surgeries is still of a major concern in this private rural tertiary hospital with most of the reasons easily preventable through proper scheduling of patients, improved communication between surgical teams and with patients; and effective utilization of available resources and man power.

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.

Scoring System to Triage Patients for Spine Surgery in the Setting of Limited Resources

INTRODUCTIONAs of May 04, 2020, the COVID-19 pandemic has affected over 3.5 million people and touched every inhabited continent. Accordingly, it has stressed health systems the world over leading to the cancellation of elective surgical cases and discussions regarding healthcare resource rationing. It is expected that rationing of surgical resources will continue even after the pandemic peak, and may recur with future pandemics, creating a need for a means of triaging emergent and elective spine surgery patients.METHODSUsing a modified Delphi technique, a cohort of 16 fellowship-trained spine surgeons from 10 academic medical centers constructed a scoring system for the triage and prioritization of emergent and elective spine surgeries. Three separate rounds of videoconferencing and written correspondence were used to reach a final scoring system. Sixteen test cases were used to optimize the scoring system so that it could categorize cases as requiring emergent, urgent, high-priority elective, or low-priority elective scheduling.RESULTSThe devised scoring system included 8 independent components: neurological status, underlying spine stability, presentation of a highrisk post-operative complication, patient medical comorbidities, expected hospital course, expected discharge disposition, facility resource limitations, and local disease burden. The resultant calculator was deployed as a freely-available web-based calculator: https://jhuspine3.shinyapps.io/SpineUrgencyCalculator/CONCLUSIONHere we present the first quantitative urgency scoring system for the triage and prioritizing of spine surgery cases in resource-limited settings. We believe that our scoring system, while not all-encompassing, has potential value as a guide for triaging spine surgical cases during the COVID pandemic and post-COVID period.

Scoring System to Triage Patients for Spine Surgery in the Setting of Limited Resources: Application to the Coronavirus Disease 2019 (COVID-19) Pandemic and Beyond

BackgroundAs of May 4, 2020, the coronavirus disease 2019 (COVID-19) pandemic has affected >3.5 million people and touched every inhabited continent. Accordingly, it has stressed health systems worldwide, leading to the cancellation of elective surgical cases and discussions regarding health care resource rationing. It is expected that rationing of surgical resources will continue even after the pandemic peak and may recur with future pandemics, creating a need for a means of triaging patients for emergent and elective spine surgery.MethodsUsing a modified Delphi technique, a cohort of 16 fellowship-trained spine surgeons from 10 academic medical centers constructed a scoring system for the triage and prioritization of emergent and elective spine surgeries. Three separate rounds of videoconferencing and written correspondence were used to reach a final scoring system. Sixteen test cases were used to optimize the scoring system so that it could categorize cases as requiring emergent, urgent, high-priority elective, or low-priority elective scheduling.ResultsThe devised scoring system included 8 independent components: neurologic status, underlying spine stability, presentation of a high-risk postoperative complication, patient medical comorbidities, expected hospital course, expected discharge disposition, facility resource limitations, and local disease burden. The resultant calculator was deployed as a freely available Web-based calculator (https://jhuspine3.shinyapps.io/SpineUrgencyCalculator/).ConclusionsWe present the first quantitative urgency scoring system for the triage and prioritizing of spine surgery cases in resource-limited settings. We believe that our scoring system, although not all encompassing, has potential value as a guide for triaging spine surgical cases during the COVID pandemic and post-COVID period.

Cancellation of elective surgical cases in a nigerian teaching hospital: Frequency and reasons.

Dwindling economic resources and reduced manpower in the health sector require efficient use of the available resources. Day of surgery cancellation has far reaching consequences on the patients and the theatre staff involved. Full use of the theatre space should be pursued by every theatre user. The study aimed to report on the rates and causes of day of surgery cancellation of elective surgical cases in our hospital as a means towards proffering solutions. It was a retrospective study of all elective cases that were booked over a 15-month period from January 2016 to March 2017. Cancellation was said to have occurred when the planned surgery did not take place on the proposed day of surgery. Cancellations were categorized into patient-related, surgeon-related, hospital-related and anesthetist-related. Reasons for the cancellations were documented. Data were analyzed using Statistical Package for the Social Sciences (SPSS) software program, version 22. Variables were compared using Chi-square tests. A value of P < 0.05 was considered statistically significant. During the 15-month period, a total of 1296 elective surgeries were booked. Of this, 118 (9.1%) cases were cancelled. Patient-related factor was the most common reason (47.5%) followed by surgeon-related factor (28%). Lack of funds was the most common patient related-reason for cancellation. Majority of the cancelled cases were general surgical cases (36.4%) followed by orthopedics (25.4%) and urology (11%). Seventy percent of the cancelled cases were first and second on the elective list. The cancellation rate in this study is high. The reasons for these cancellations are preventable. To ensure effective use of the theatre, efforts should be made to tackle these reasons.

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.

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.

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.

Cancellation of operations in Saudi Arabian hospitals: Frequency, reasons and suggestions for improvements.

Objective:To identify the frequency and reasons of operations cancellation in 25 Makkah region hospitals in Saudi Arabia.Methods:Retrospective evaluation of the rate of surgery cancellation in 25 hospitals of Makkah region was performed in this study. The data of scheduled surgeries from 15 different surgical specialties was collected from January to December 2013. Frequency and reasons of cancellation of elective surgical cases in different specialty were studied with a view to recommend suggestions for improvement. Data was analyzed on SPSS -16.Results:There are 120 operating rooms (OR) in 25 Makkah region hospitals and during the year 2013, a total of 16,211 surgery cases were listed, and 1,238 (7.6%) cases were canceled. Contribution to total cancellation was highest in orthopedic 33.8% followed by general surgery 27.5%, obstetrics 7.7% and ENT 5.2%. According to category, 42.81% rate of cancellation was patient related, 20.03% facility related, 9.45% due to improper work-up, 1.45% associated with anesthesia, 7.19% related to surgeons, and 18.90% other/and not recorded reasons.Conclusions:Present study found 7.6% cancelation rate in Makkah region hospitals and three most common causes for cancellations were patients related, facility related and improper work-up.

What impact did a Paediatric Early Warning system have on emergency admissions to the paediatric intensive care unit? An observational cohort study

The ideology underpinning Paediatric Early Warning systems (PEWs) is that earlier recognition of deteriorating in-patients would improve clinical outcomes. To explore how the introduction of PEWs at a tertiary children's hospital affects emergency admissions to the Paediatric Intensive Care Unit (PICU) and the impact on service delivery. To compare 'in-house' emergency admissions to PICU with 'external' admissions transferred from District General Hospitals (without PEWs). A before-and-after observational study August 2005-July 2006 (pre), August 2006-July 2007 (post) implementation of PEWs at the tertiary children's hospital. The median Paediatric Index of Mortality (PIM2) reduced; 0.44 vs 0.60 (p<0.001). Fewer admissions required invasive ventilation 62.7% vs 75.2% (p=0.015) for a shorter median duration; four to two days. The median length of PICU stay reduced; five to three days (p=0.002). There was a non-significant reduction in mortality (p=0.47). There was no comparable improvement in outcome seen in external emergency admissions to PICU. A 39% reduction in emergency admission total beds days reduced cancellation of major elective surgical cases and refusal of external PICU referrals. Following introduction of PEWs at a tertiary children's hospital PIM2 was reduced, patients required less PICU interventions and had a shorter length of stay. PICU service delivery improved.

Cancellation of elective surgical procedures in the Genito-Urinary section of National Hospital of Sri Lanka – can we do better?

Background Cancellation of elective surgical procedures on the day of surgery is a parameter to assess the quality of patient care and the quality of the management system. There are many reasons for cancellation of elective surgical cases; and they differ from unit to unit and hospital to hospital. There are many causes such as medical, surgical, administrative, anaesthetic and patient factors. Materials and Method We prospectively collected data over a four month period from May to August 2012 in the Genito-Urinary section of National Hospital of Sri Lanka to determine the prevalence and causes for cancellation of elective surgical procedures. Results 1724 patients were scheduled for elective surgical procedures during the study period; 106 (6.0%) of these were cancelled on the day of surgery. 16.9% (18/106) of patients defaulted admission. Majority of the cancellations were within the 61 – 70 year age group (31.1%) The cancellations of major, intermediate and minor surgeries were 58.5%, 18.9%, 22.6% respectively. Conclusion and Recommendations Ideally there should be no cancellations. Cancellations can be minimized if the patients with medical problems were detected early and referred for an anaesthetic assessment soon after they are scheduled for surgery. Cancellation due to lack of theatre time should be minimised with proper planning. It is worth looking at why nearly 17% of patients defaulted. There may have been problems with communication. Minimising cancellations will improve operating room efficiency and reduce wastage of time and money. DOI: http://dx.doi.org/10.4038/slja.v21i2.5390

Elective surgical case cancellation in the Veterans Health Administration system: identifying areas for improvement

Background This study evaluated elective surgical case cancellation (CC) rates, reasons for these cancellations, and identified areas for improvement within the Veterans Health Administration (VA) system. Methods CC data for 2006 were collected from the scheduling software for 123 VA facilities. Surveys were distributed to 40 facilities (10 highest and 10 lowest CC rates for high- and low-volume facilities). CC reasons were standardized and piloted at 5 facilities. Results Of 329,784 cases scheduled by 9 surgical specialties, 40,988 (12.4%) were cancelled. CC reasons (9,528) were placed into 6 broad categories: patient (35%), work-up/medical condition change (28%), facility (20%), surgeon (8%), anesthesia (1%), and miscellaneous (8%). Survey results show areas for improvement at the facility level and a standardized list of 28 CC reasons was comprehensive. Conclusions Interventions that decrease cancellations caused by patient factors, inadequate work-up, and facility factors are needed to reduce overall elective surgical case cancellations.