Last-minute Cancellation Research Articles

Last minute cancellation of elective lung cancer surgery is associated with poorer survival.

Our objective was to assess the incidence and reason of last-minute cancellations before surgery for lung cancer and their association with outcomes. Retrospective analysis on all consecutive patients booked for elective lung cancer surgery from January 2017 through December 2022 in a single centre.Last minute cancellation: a cancellation occurring within the last 24 hours from the planned operation. Cancellation categories: process-related and patient-related.The short-term and long-term outcomes of patients who experienced a last-minute cancellation were analysed. 197 patients of 1587 (12%) had a last-minute cancellation: 156 (79%) were process-related and 41 (21%) were patient-related.3% (5/156) of patients cancelled for process reasons did not receive surgery vs 39% (16/41) of those cancelled for patient-related reasons, p < 0.0001.The 90-day mortality rates of cancelled and non-cancelled patients were similar (4.6% vs 4.7%, p = 1).Five-year overall survival of patients with cancellation was 58% (95% CI 49-66) vs 69% (95% CI 66-71) of those without cancellations, p = 0.022.Among those who had a cancellation, the 5-year OS of those with process-related cancellations was 61% (52-60) vs 35% (14-58) of those with patient-related cancellations (adjusted p value for multiple comparisons = 0.14).Cox regression analysis showed that surgery cancellations within the last 24 hours for patient-related (HR 1.87, 95% CI 1.02-3.42, p = 0.043) reasons remained a factor associated with poorer overall survival after adjusting for clinical stage, type of operation and patient related variables. Implementing the patient's preoperative clinical evaluation to reduce the occurrence of related last-minute cancellations might mitigate its negative impact on survival.

Machine Learning-Based Approach to Predict Last-Minute Cancellation of Pediatric Day Surgeries.

The last-minute cancellation of surgeries profoundly affects patients and their families. This research aimed to forecast these cancellations using EMR data and meteorological conditions at the time of the appointment, using a machine learning approach. We retrospectively gathered medical data from 13 440 pediatric patients slated for surgery from 2018 to 2021. Following data preprocessing, we utilized random forests, logistic regression, linear support vector machines, gradient boosting trees, and extreme gradient boosting trees to predict these abrupt cancellations. The efficacy of these models was assessed through performance metrics. The analysis revealed that key factors influencing last-minute cancellations included the impact of the coronavirus disease 2019 pandemic, average wind speed, average rainfall, preanesthetic assessments, and patient age. The extreme gradient boosting algorithm outperformed other models in predicting cancellations, boasting an area under the curve value of 0.923 and an accuracy of 0.841. This algorithm yielded superior sensitivity (0.840), precision (0.837), and F1 score (0.838) relative to the other models. These insights underscore the potential of machine learning, informed by EMRs and meteorological data, in forecasting last-minute surgical cancellations. The extreme gradient boosting algorithm holds promise for clinical deployment to curtail healthcare expenses and avert adverse patient-family experiences.

Selective centralized booking as a low-cost alternative to centralized referral.

SummaryCentralized referral systems have been successfully implemented to shorten and equalize surgical wait times; however, ongoing expenses make sustaining these projects challenging. We trialed a low-cost centralized booking project for hernia surgery in a community hospital from July to November 2019. Eligible patients (i.e., those with visible or palpable inguinal or umbilical hernias who were agreeable to an open mesh repair) were booked with the first available surgeon after initial consultation. Centrally booked patients with either inguinal or umbilical hernias waited a mean of 82 (standard deviation [SD] 32) and 80 (SD 66) days, respectively, while those who did not use the centralized system waited 137 (SD 89) and 181 (SD 92) days, respectively. Centralized booking increased operating room utilization as a larger pool of patients was available to call when last-minute cancellation occurred; centralized booking also effectively equalized wait-lists among 6 surgeons. Selective centralized booking is a promising concept that led to more efficient utilization of available operating room time with a significant decrease in wait times; this system could potentially improve access for all patients awaiting general surgery without requiring additional funding.

When a Pandemic Cancels Pride: an Exploration of How Stakeholders Respond to the Cancellation Of a Rural Australian Pride Event

Pride events challenge hegemonic notions of sexuality and gender within places they are held. This is particularly the case in rural communities that are perceived, rightly or wrongly, as prejudices towards individuals with a diverse sexuality or gender identity. However, although academic literature has extensively explored Pride events within an urban context, limited attention has been paid to the rural context, and still little to those in their infancy. This article examines how stakeholders responded to the cancellation of a Pride event in the Australian rural township of Wagga Wagga due to COVID19. The pandemic, in this context, provided an opportunity to understand attitudes towards the event and its cancellation. Through this process, eight topics were identified as: council funding, cancellation as homophobic, last-minute cancellation, cancellation regretted, cancellation supported, organizers acknowledged, LGBTIQI+, and Pride event. Based on these findings, implications for the cancellation of social contentious events in response to such circumstances are identified. These implications suggest the need for a more considered approach to communicating about the cancellation to prevent allegations of prejudice and demonstrate the value of such events.

Last-minute cancellation of adult patients scheduled for cardiothoracic surgery in a large Dutch tertiary care centre.

OBJECTIVESUnanticipated cancellation of a surgical procedure is a common problem, causing distress to the patient and increases in healthcare costs. However, limited evidence exists on the effects of last-minute cancellations of cardiothoracic surgical procedures in particular. The goal of this study was to gain insight into the prevalence of and the reasons for last-minute cancellations and to examine whether cancellation is associated with adverse medical outcomes.METHODSPatients who were scheduled for elective cardiothoracic surgical procedures between January 2017 and June 2019 were evaluated. The reasons for the cancellations were assigned to the categories medically related or process related. We examined the differences in patient characteristics between those designated as no cancellation, medically related cancellations and process-related cancellations. Lastly, we examined the outcomes of patients who experienced a last-minute cancellation of a scheduled operation.RESULTSA total of 2111 patients were included; of these, 301 (14.3%) had last-minute cancellations. In 78 (26%) cases, the cancellations were attributable to medical reasons (e.g. infection, comorbidities); 215 (71%) of the cancellations were process related (e.g. another patient in more urgent need of surgery, lack of staff). Almost 99% of the operations with a process-related cancellation were rescheduled compared to only 71.8% of the medically related cancelled operations (P < 0.001). Patients with a medically related cancellation had significantly higher 1-year mortality than patients who had no cancellation (unadjusted hazard ratio 2.50; 95% confidence interval, 1.30–4.78; P = 0.006); after adjustment for the EuroSCORE II, this effect remained significant.CONCLUSIONSLast-minute cancellations were commonly seen in our cohort, and the reasons for cancellation were significantly related to adverse medical outcomes.

Canceling Last Minute in Italian and Colombian Spanish: A Cross-Cultural Account of Pragmalinguistic Strategies

This study is part of a larger research project aiming to gather and compare last-minute cancellations in different languages. The corpus, collected through an online DCT, is being annotated with NVivo software according to a set of pragmatic categories. These are derived from previous cross-cultural studies (Blum-Kulka et al. in Cross-cultural pragmatics: requests and apologies, Ablex, Norwood, 1989; Beebe et al. in Developing communicative competence in a second language, Newbury House, New York, 1990) and integrated with new ones identified in the corpus, following a data-driven approach. Declining an invitation poses a threat to the invitee’s positive face, because it shows noncompliance with the inviter’s desire to share time and friendship with the invitee. A last-minute cancellation is potentially threatening for negative face, as it interferes with the inviter’s plans, but it may save positive face because the invitee attributes her/his absence to an unforeseen and unavoidable circumstance. Little research has been devoted to both Italian and Colombian Spanish from a cross-cultural pragmatic perspective, whereas other varieties of Spanish have received more attention in this regard (see Garcia and Placencia 2007). The present study aims to fill this gap by exploring the pragmalinguistic strategies Italians and Colombians consider appropriate to use when canceling last minute. Frequency and distribution of speech act components and internal modifiers were compared between Colombian and Italian native speakers’ last-minute cancellations (n = 753). The significance of the observed differences was assessed by Chi squared test. Results show interesting differences at the pragmalinguistic level, suggesting that Italians prefer more complex and mitigated last-minute cancellations in comparison to Colombians.

Reduction of last-minute cancellations in elective urology surgery: A quality improvement study.

Last minute cancellations of elective surgery negatively impact both patients and hospitals, leading to inefficient use of resources, reduced capacity and increased waiting lists. The aims of the study were: to determine the last-minute cancellation rates in a tertiary urology department, to analyse the reasons driving cancellations, and to implement targeted solutions. Process mapping was used to analyse the patient journey, and a retrospective service evaluation of 6 months of urology operations was conducted. Interventions were designed based on addressing the most common cancellation reasons, and the audit cycle was completed with a further 6 months of post-intervention data collection. In the first 6 month period we reviewed, there were 2773 scheduled operations, of which 334 resulted in a last minute cancellation (12% of scheduled operations). The top four cancellation reasons were: Targeted interventions, including a reminder telephone call, resulted in a modest reduction (0.2%) in the rate of last-minute cancellations in the following 6 months. Cancelled operations represent poor use of resource. The bulk of common cancellation reasons can be addressed with a reminder telephone call covering admission instructions.

Mining patient-specific and contextual data with machine learning technologies to predict cancellation of children’s surgery

BackgroundLast-minute surgery cancellation represents a major wastage of resources and can cause significant inconvenience to patients. Our objectives in this study were: 1) To develop predictive models of last-minute surgery cancellation, utilizing machine learning technologies, from patient-specific and contextual data from two distinct pediatric surgical sites of a single institution; and 2) to identify specific key predictors that impact children’s risk of day-of-surgery cancellation. Methods and findingsWe extracted five-year datasets (2012–2017) from the Electronic Health Record at Cincinnati Children’s Hospital Medical Center. By leveraging patient-specific information and contextual data, machine learning classifiers were developed to predict all patient-related cancellations and the most frequent four cancellation causes individually (patient illness, “no show,” NPO violation and refusal to undergo surgery by either patient or family). Model performance was evaluated by the area under the receiver operating characteristic curve (AUC) using ten-fold cross-validation. The best performance for predicting all-cause surgery cancellation was generated by gradient-boosted logistic regression models, with AUC 0.781 (95% CI: [0.764,0.797]) and 0.740 (95% CI: [0.726,0.771]) for the two campuses. Of the four most frequent individual causes of cancellation, “no show” and NPO violation were predicted better than patient illness or patient/family refusal. Models showed good cross-campus generalizability (AUC: 0.725/0.735, when training on one site and testing on the other). To synthesize a human-oriented conceptualization of pediatric surgery cancellation, an iterative step-forward approach was applied to identify key predictors which may inform the design of future preventive interventions. ConclusionsOur study demonstrated the capacity of machine learning models for predicting pediatric patients at risk of last-minute surgery cancellation and providing useful insight into root causes of cancellation. The approach offers the promise of targeted interventions to significantly decrease both healthcare costs and also families’ negative experiences.

Dien Bien Phu, Soviet Ballet, and the Cold War: The First Paris Tour, May 1954

In May 1954, the battle of Dien Bien Phu in Indochina led French governmental authorities to cancel the first tour to Paris by any Soviet ballet troupe since World War II. Drawing from press accounts as well as material in diplomatic archives and the Paris Opera, this essay explores the negotiations behind the tour, its last-minute cancellation after the Soviet dancers had reached Paris, and French reaction to the aborted tour. In particular, I examine the political considerations of the early Cold War period that prematurely terminated the French-Soviet efforts to conduct dance diplomacy.

The Role of Conferences on the Pathway to Academic Impact

This paper provides evidence for the role of conferences in generating visibility for academic work, using a ‘natural experiment’: the last-minute cancellation –due to ‘Hurricane Isaac’–of the 2012 American Political Science Association (APSA) Annual Meeting. We assembled a dataset containing outcomes of 15,624 articles scheduled to be presented between 2009 and 2012 at the APSA meetings or at a comparator annual conference (that of the Midwest Political Science Association). Our estimates are quanti…ed in

Role of telehealth in perioperative medicine for regional and rural patients in Queensland.

Australians living in regional, rural and remote areas face a myriad of complexities resulting in a trend to poorer health outcomes. Telehealth is being utilised as an alternative mode of service delivery to overcome such barriers. However, there is limited published information concerning the use of telehealth in perioperative medicine. To review the performance of the telehealth preoperative assessment service at Mater Hospital Brisbane to determine last-minute cancellation rates secondary to medical reasons. A retrospective chart audit of all patients referred to perioperative medicine telehealth consultation services was provided at Mater Hospital Brisbane. During a 1-year period, 229 patients across eight surgical subspecialties were referred for telehealth assessment (85 females, 144 males) with a median age of 67 years. Patients lived a median distance of 1597 km from Brisbane. Of the 229 patients included in the study, 7 (3.1%) experienced last-minute cancellations. From these data, the last-minute cancellation rate due to medical reasons was 1.3%, which is consistent with the international average. The Mater Hospital Perioperative Medicine Telehealth Programme is a means of providing comprehensive perioperative assessment to regional, rural and remote patients that result in reduced last-minute surgical cancellations and surgery within or below the national recommended guidelines.

Improving patient flow and satisfaction: An evidence-based pre-admission clinic and transfer of care pathway for elective surgery patients

AimsTo redesign, implement and evaluate a Pre-Admission Clinic incorporated with a Transfer of Care Pathway for elective surgery patients. MethodsAn evidence-based approach was used to redesign the Pre-Admission Clinic and the Transfer of Care Pathway. The impact of the pre-admission clinic and the care pathway was evaluated. De-identified data containing patient outcomes was collected from the hospital electronic medical record system from May 2014 to March 2015. Outcome measures included surgical cancellations, last-minute cancellations, average length of stay, discharge delays, and adverse events that were compared pre and post-implementation. Patient satisfaction was measured pre and post-implementation by using a modified version of Best Practice hospital survey. ResultsA total of 10,854 eligible cases were included (5716 in the pre-implementation period and 5138 in the post-implementation period). The overall cancellation rate remained relatively stable (p=0.95), however, the last-minute cancellation rate was reduced post-implementation (p=0.02). Although no difference was observed in average length of stay (p=0.39), the percentage of discharge delays was reduced (p=0.027). The incidence of adverse events was too low to draw statistical conclusion. A sample of 102 patients completed the patient satisfaction survey. The overall satisfaction improved post-implementation (p=0.03). ConclusionsThe evidence-based Pre-Admission Clinic and the Transfer of Care Pathway had a positive impact on last-minute surgical cancellations, discharge delays and patient satisfaction.

PC-010 断り表現において受け手が注目する要素の検討 : 眼球運動を用いた実験的検討(社会,ポスター発表)

PC-010 断り表現において受け手が注目する要素の検討 : 眼球運動を用いた実験的検討(社会,ポスター発表)

James Tweedie,The Age of New Waves: Art Cinema and the Staging of Globalization.

Judging by the capacity audience at a workshop on ‘The world cinema turn in film studies’ at the 2015 Society for Cinema Studies Conference in Montréal, debates around ‘global art cinema’ continue to be of keen interest to scholars. No doubt many had gathered to hear Dudley Andrew, who unfortunately made a last-minute cancellation. By imagining world cinema as more nuanced and multidimensional than it has traditionally been categorized, Andrew suggests in his 2004 essay, ‘An atlas of world cinema’, that ‘a wider conception of national image culture is around the corner, prophesied by phrases like “rooted cosmopolitanism” and “critical regionalism”’. 1 James Tweedie’s The Age of New Waves: Art Cinema and the Staging of Globalization exemplifies this new conception, connecting the core aesthetic principles of the French new wave to the new waves of China and Taiwan. Rather than thinking of the French new wave as an origin, the author sees the three cinemas as creating a feedback loop without hierarchy. This theory attempts to coalesce western and nonwestern cinemas within the same canon, disregarding national, cultural and political differences. Tweedie establishes globalization as the link that connects these cinemas, in particular the ‘urban, youth and consumer revolutions’ that formed all of them to one degree or another. In many ways this well-researched and theorized volume succeeds in breaking down old, Eurocentric taxonomies of film studies as well as bringing a fresh and welcome perspective to defining ‘world cinema’, a critical debate that continues to build interest.

Descemet Membrane Endothelial Keratoplasty

To evaluate the learning curve of standardized "no-touch" Descemet membrane endothelial keratoplasty (DMEK) of a single surgeon in a clinic without an in-house eye bank facility. For 25 eyes of 22 patients, Descemet graft preparation and DMEK surgery were performed according to the protocols of the Netherlands Institute for Innovative Ocular Surgery with minor modifications. Best spectacle-corrected visual acuity, subjective refraction, Scheimpflug tomography, and endothelial cell density of the donor tissue were documented before and at 1, 3, and 6 months after the surgery; intraoperative and postoperative complications were recorded. No donor tissue was lost owing to preparation failure of the Descemet graft allowing all surgeries to be completed as planned. At 6 months after the surgery, 83% of eyes reached ≥ 20/40 (≥ 0.5), 48% ≥ 20/28 (≥ 0.8), and 30% (7/23) ≥ 20/20 (≥ 1.0) (n = 23). The mean change in both spherical equivalent and refractive cylinder in the same interval was minimal (0.03 diopter). Mean donor endothelial cell density decreased from 2444 cells per square millimeter (± 198 cells/mm2) before the surgery to 1331 cells per square millimeter (± 491 cells/mm2) at 6 months after the surgery. Partial graft detachment requiring rebubbling occurred in 9 cases (36%). One eye developed primary graft failure. This case series shows that DMEK by a beginning surgeon can achieve good results without preparing the graft in an eye bank. Use of backup tissue can be avoided by strictly adhering to the Netherlands Institute for Innovative Ocular Surgery techniques and by harvesting the graft the day before surgery to avoid last-minute cancellation.

The Effect of Expressions of Last-minute Cancellation on Relationship Maintenance

The Effect of Expressions of Last-minute Cancellation on Relationship Maintenance

Sharing Decision Making About Cardiac Surgery

Aortic valve replacement surgery is the only available treatment option able to improve survival in patients with symptomatic and severe aortic valve stenosis. Without surgical intervention, patients with symptomatic dyspnea and severe aortic valve stenosis have a median survival less than 2 years. In an ideal, patient-centered healthcare system, the decision whether to undergo risky yet potentially life-prolonging surgery should not only reflect judicious application of the evidence of safety and efficacy of the surgery, but it also should be consistent with the patient’s clinical and personal contexts, and their goals, values, and preferences for life and healthcare. Article see p 533 The report by Bach et al1 is the latest in their series of investigations to uncover why cardiac valve replacement surgery is underused among eligible candidates. In this report, they seek explanations among patient, clinician, and hospital-level characteristics and suggest the following hypothesis: clinicians, particularly cardiologists, are making apparently inconsistent judgments as to which patients should be referred to cardiac surgeons for consideration of aortic valve replacement. Among 191 patients with severe aortic valve stenosis who did not undergo cardiac surgery, a cardiologist evaluated 182 (95%), but referred only 57 (30%) to a cardiac surgeon. In this editorial, we will place this finding in the context of the evolving field of shared decision-making and suggest how this focus could improve the quality of care delivered to patients with valvular heart disease. Shared decision making is a 3-step process.2 The first step involves knowledge transfer. In its idealized form, shared decision making requires symmetrical and bidirectional exchange of information between patients and clinicians. This exchange aims to identify and distinguish the available options under consideration, including the option of no treatment. The other 2 steps require the patient and clinician to (1) actively engage in deliberating (ie, …

Effectiveness of nurse-led preoperative assessment services

Effectiveness of nurse-led preoperative assessment services

Preoperative assessment by nurses

To redesign, implement and evaluate a Pre-Admission Clinic incorporated with a Transfer of Care Pathway for elective surgery patients.An evidence-based approach was used to redesign the Pre-Admission Clinic and the Transfer of Care Pathway. The impact of the pre-admission clinic and the care pathway was evaluated. De-identified data containing patient outcomes was collected from the hospital electronic medical record system from May 2014 to March 2015. Outcome measures included surgical cancellations, last-minute cancellations, average length of stay, discharge delays, and adverse events that were compared pre and post-implementation. Patient satisfaction was measured pre and post-implementation by using a modified version of Best Practice hospital survey.A total of 10,854 eligible cases were included (5716 in the pre-implementation period and 5138 in the post-implementation period). The overall cancellation rate remained relatively stable (p = 0.95), however, the last-minute cancellation rate was reduced post-implementation (p = 0.02). Although no difference was observed in average length of stay (p = 0.39), the percentage of discharge delays was reduced (p = 0.027). The incidence of adverse events was too low to draw statistical conclusion. A sample of 102 patients completed the patient satisfaction survey. The overall satisfaction improved post-implementation (p = 0.03).The evidence-based Pre-Admission Clinic and the Transfer of Care Pathway had a positive impact on last-minute surgical cancellations, discharge delays and patient satisfaction.

Comparison of the Effectiveness of Different Preoperative Screening Methods: Telephone Interview versus Hospital Visit

There are several commonly used approaches to screening patients for surgery. Each method has its advantages and disadvantages for the patients and physicians. The effectiveness of these various methods has not been objectively compared. The study is designed to compare the effectiveness to prevent last-minute cancellations by anesthesiologists between hospital visit and telephone interviews. We performed this prospective observational study to compare the effectiveness to prevent lastminute cancellations by anesthesiologists between hospital visit and telephone interviews. All patients scheduled for various surgeries during one-month period in the two different facilities were included in the study. In the telephone interview group, there were total 334 cases during one-month period. In the hospital visit group, there were total 348 cases during one-month period. Last-minute cancellation by anesthesiologists did not differ significantly between telephone interview (2/334) and hospital visit groups (3/348) (p = 0.956). In conclusions: telephone interview and hospital visit are effective preoperative screening methods to avoid last-minute cancellation.