Reasons For Cancellation Research Articles

Interpretation of The Phrase “Coercion” in The Compilation of Islamic Law as Reasons for Cancellation of Marriage

Marriage is a common thing in society with ubudiyyah elements in it. However, legal issues often accompany the sanctity of the marriage bond itself, such as the cancellation of a marriage due to an element of coercion from a third party. Article 71 Compilation of Islamic Law (KHI) states that one of the reasons for being able to apply for a marriage cancellation is because of coercion when the marriage took place. The purpose of this study is to analyze the meaning of the phrase "coercion" as a reason for annulment of marriage and its accompanying legal implications. This type of research is classified as normative-empirical legal research using a statutory approach and a conceptual approach plus a sociological approach as a tool. This research refers to a variety of primary, secondary and tertiary legal materials compiled and traced through literature studies and interviews with judges of the Religious Courts. The legal materials that have been collected are then analyzed descriptively and analytically. The results showed that what is meant by coercion in marriage is a marriage that occurs not because of one's own will or feels that he is under threat. As a form of legal consequence, annulment of a marriage by force is different from divorce, where the marriage bond that occurred before the breakup of the marriage is considered never to have occurred.

PONIŠTAJ ARBITRAŽNE ODLUKE DONETE OD STRANE AGENCIJE ZA MIRNO REŠAVANjE RADNIH SPOROVA

Word of the dispute is primarily associated with the intervention of the court. This is a traditional way of resolving labor disputes. The tendency in the world is to get as many of these disputes resolved peacefully, fast and fair manner at low cost. Avoiding court decision increases the chance of finding a favorable solution to the two opposing sides. The content of an arbitration agreement is of great importance to the parties in the arbitration proceedings. An arbitration agreement express the contractual freedom of the parties and list of facultative elements of an arbitration. Main benefits from peaceful solving labor disputes are expediency and cheap costs of the arbitration process. The arbitratior represents quasi – judicial instance and him may be wrong in his decision. The decision process is single and there is no possibility of appeal. This option would slow down the process of resolving issues. But, it can not be situation that would not be any way to void the wrong decision of the arbitratior. It could be chance to avoid this situation. Exactly because of that case, it must be provided for the possibility of annulment decision from peaceful settlment labor disputes agency. Reasons for cancellation must be a procedural character. Courts should not enter into the merits because it would further slow the troubleshooting. This would replicate the slowness of the trial in arbitration deciding. This length of proceedings before the courts is contary to the idea of arbitration as a quick, cheap, efficient and above all peacefull methods of resolving labor disputes. Court in relation to arbitration should have only a supervisory function. Blending the merits of arbitartion decisions would be deprived of independence and efficiency.

The Challenges of Coal Phaseout: Coal Plant Development and Foreign Finance in Indonesia and Vietnam

AbstractGlobal coal use must be phased out if we are to minimize temperature increases associated with climate change. Most new coal plants are being built in the Asia Pacific and rely on overseas finance, with Indonesia and Vietnam the leading recipients. However, the politics of coal plant finance are changing, with many projects cancelled in recent years. This article explores the factors that led to coal plant cancellations in Vietnam and Indonesia. Based on new data of coal plant finance and elite interviews, we find fuel switching, public opposition, and national planning were the dominant reasons for cancellations in Vietnam, while Indonesia’s reasons were more diverse. Vietnam also had a larger number of cancellations than Indonesia, which has a more entrenched domestic coal mining sector. These findings suggest that Vietnam is farther along the coal phaseout agenda than Indonesia. We further provide provisional explanations for these patterns.

Investigating Barriers to Completion of Postpartum Tubal Ligation: A Retrospective Chart Review.

To identify the completion rate for postpartum tubal ligation (PPTL) and predictors of noncompletion of PPTL in a central New Jersey population. We conducted a retrospective chart review at a tertiary care center in New Jersey for patients delivering during an 18-month period. We used the electronic medical record to identify all of the patients who had documented desire for a PPTL at the time of admission. We calculated the rate of PPTL completion and identified predictors of completion and risk factors for noncompletion. We recorded any documented reasons for cancellation and choice of contraception after noncompletion. Of 626 women who requested PPTL on admission, 508 (81.2%) procedures were performed. The most common reasons for noncompletion were patient changing her mind (38.1%) and unknown/not documented (22.9%). Cesarean delivery was the strongest predictor of completion, with 93.4% completion among cesarean deliveries compared with 65.6% among vaginal deliveries (P < 0.01). Lack of insurance also was associated with noncompletion (P < 0.01). There was no difference in body mass index (P = 0.75), gravidity (P = 0.99), parity (P = 0.72), or high-risk status (P = 0.47) between completed and noncompleted PPTL. Cesarean delivery is a strong predictor of PPTL completion, most likely because of easier availability of the operating room, anesthesia, and ancillary staff. Body mass index, gravidity, and parity are not associated with PPTL completion. Future research should focus on exploring whether this association is system, provider, or patient dependent.

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. 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. 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. Conclusion: The majority of the reasons for cancellation should have been avoided with proper list preparation and the surgical team's meticulous planning.

TP10.2.4Access surgery for dialysis patients during COVID-19

AimsTo describe the organisation of a triage system and COVID-19-free surgical pathway, and to assess the outcomes after its implementation for planned dialysis access surgery for patients during the first wave of the COVID-19 pandemic in the UK.MethodsIn response to the suspension of elective operations due to SARS-CoV-2 outbreak, we devised a COVID-19 free surgical pathway performed in NHS and an independent hospital. We audited the outcomes of its application in patients requiring access surgery between 17 April and 15 September 2020. The data was collated, analysed, and presented at clinical governess. We are looking to re-audit for the second wave in the coming months.ResultsA total of 235 cases were listed, and 203 procedures were performed. Thirty-two cases were cancelled and the top reason for cancellation was patient refusal. Of the procedures carried out, 47% (n = 96) were arteriovenous fistula formation, 42% (n = 84) were peritoneal catheter procedures, and 11% (n = 23) were arteriovenous grafts. The postoperative complication rate by day 7 was 13.3% (n = 27), by day 30 was 6.9% (n = 14) and they are similar to pre-COVID outcomes.By performing a definitive dialysis access, we avoided the significant morbidity and mortality associated with tunnel-line based dialysis. No patients acquired COVID-19 or died from its related illnesses in 30 days.ConclusionOur results confirmed that our pathway was effective in delivering dialysis access in a timely manner and COVID safe. Our model is safe, easy to replicate COVID-19-free pathway and can be used during similar challenges in the future.

Effectiveness of SPECT/CT Imaging for Sentinel Node Biopsy Staging of Primary Cutaneous Melanoma and Patient Outcomes

PurposeCoregistered SPECT/CT can improve accuracy of sentinel node biopsy (SNB) for staging melanoma. This benefit has implications for pathology services and surgical practice with increased diagnostic and surgical workload. The purpose of this study was to investigate the effectiveness of SPECT/CT imaging.MethodsSNB data were collected over a 10-year period. Preoperative SLN mapping was performed by using planar lymphoscintigraphy (LSG) for all patients (n = 1522) and after October 2015, patients underwent a second co-registered SPECT/CT scan (n = 559). The patients were stratified according to the imaging protocol. The number of nodes and nodal basins were assessed. The reasons for cancellation also were assessed.ResultsA total of 95% (1446/1522) of patients underwent a successful SNB procedure. Significantly more sentinel nodes were identified by the SPECT/CT protocol (3 vs. 2; p < 0.0001). More patients were cancelled in the SPECT/CT cohort (9.3% vs. 2.5%; p < 0.0001). Head & neck, lower limb, and AJCC IB primaries were significantly less likely to proceed to SNB. SPECT/CT identified significantly more positive SNBs (20.9% vs. 16.5%; p = 0.038). SPECT/CT imaging was associated with improved disease-free (hazard ratio [HR] = 0.74; 95% confidence interval [CI]: 0.54–1.0); p = 0.048) and disease-specific survival (HR = 0.48; 95% CI: 0.3–0.78; p = 0.003). Patients who did not proceed to SNB had a significantly increased nodal relapse rate (23.5% vs. 6.8%; HR = 3.4; 95% CI: 1.9–6.2; p < 0.0001) compared with those who underwent SNB.ConclusionsThis large cohort study confirms the increased accuracy of SPECT/CT for identifying SLN metastases, which would appear to have a significant therapeutic benefit, although an increased risk of cancellation of the SNB procedure on the day of surgery.

Recovery of Screening Mammogram Cancellations During COVID-19

In response to the COVID-19 pandemic, the American Society of Breast Surgeons and American College of Radiology released a joint statement recommending that all breast screening studies be postponed effective March 26, 2020. A retrospective review of all canceled mammograms at a single tertiary care institution from January 1-August 31, 2020 was performed to evaluate the effect of this recommendation by quantifying both the number and reason for mammogram cancellations before and after March 26, 2020. Utilization of the electronic patient portal for appointment cancellation as a surrogate for telehealth uptake was noted. During the study period, 5340 mammogram appointments were kept and 2784 mammogram appointments were canceled. From a baseline of 30 (10.8%) canceled mammograms in January, cancellations peaked in March (576, 20.6%) and gradually decreased to a low in August (197, 7%). Reasons for cancellations varied significantly by month (P < .0001) and included COVID-19 related (236, 8.5%), unspecified patient reasons (1,210, 43.5%), administrative issues (147, 5.3%), provider requests (46, 1.7%), sooner appointments available (31, 1.1%), and reasons not given (486, 17.5%). In addition, compared to a baseline in January (51, 16.5%), electronic patient portal access peaked in August (67, 34.0%). Screening mammogram cancellations have gradually recovered after early COVID-19 restrictions were lifted and increasing use of electronic patient access appears to be sustained. Consequences for future staging at the time of diagnosis remain unknown. Understanding to what extent the pandemic affected screening may help surgeons plan for post-pandemic breast cancer care.

The Effects of Surgery Cancellation on Patients, Families, and Staff: A Prospective Cross-Sectional Study

PurposeThis study aimed to investigate the effects of surgery cancellation, as a common and never-ending problem within preoperative care, and its related factors on patients, family members, and medical staff. DesignThe research design implemented a prospective cross-sectional type. MethodsThis study was conducted for four months in two main teaching/general medical centers. The data collection tool was comprised of three researcher-made questionnaires for patients, families, and medical staff, separately. The samples also included a total number of 315 patients, family members, and medical staff. FindingsThe results revealed that the frequency distribution of all physical and emotional effects was higher in men than in women though it was not statistically significant. Each patient had been fasting for an average of 13.26 hours until the announcement of surgery cancellation. The most prevalent physical effects in the patients were hunger, thirst, and headache, respectively. The average cost of each surgery cancellation for the patients was almost twice that for the family members. There was a significant correlation between emotional effects in the patients and the families and the reason for cancellation and informants. ConclusionsEach surgery cancellation increased fasting time in patients by an average of 5 to 7 hours. Cancellation also correspondingly led to economic harms for the patients and the families, waste of operating room resources, and duplications. Since the most common reasons for surgery cancellation were patient-related and a significant correlation was observed between the reason for cancellation and emotional effects in the patients and the families, our recommendation is to strengthen patient protocols in terms of preoperative preparation and to review admission and information processes for patients undergoing surgeries.

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.

Legal Aspect of an Agreement Cancellation in the State of Majeure Force during the Pandemic Covid-19

Many parties can cancel an agreement or contract during the Covid-19 pandemic in Indonesia. WHO Director General, Tedros Adhanom Ghebreyesus determined the status of Corona Virus Disease 2019 (Covid-19) as a Pandemic This happened because the government issued Presidential Decree No. 12 of 2020 concerning the Determination of Disaster in the Spread of Corona Virus Disease 2019 (COVID-19) as a National Disaster. The covid-19 pandemic falls into the force majeure category or a state of force because it causes the economic sector to experience a decline. The community cannot do work as usual, all activities carried out are very limited. A contract is an agreement made by the parties in written form. An agreement is an act that binds one or more people to one or more people. This event resulted in a legal relationship between the parties, which included rights and obligations. Circumstances compel or force majeure may be earthquakes, fires, floods, landslides, wars, military coups, embargoes, epidemics, and so forth. In the time of the corona pandemic which is currently hitting all parts of the world, of course, it has an impact on the implementation of an agreement / contract. The purpose of this paper is to examine the force majeure in an agreement that occurs during the corona virus pandemic, which cannot automatically be used as a reason for cancellation of an agreement / contract, but can be used as a way to negotiate in canceling or changing the contents of the agreement / contract. The contract / agreement is canceled unilaterally without regard to the sense of justice, in accordance with Article 1338 paragraph (1) of the Civil Code, it is stated that the contract is a law for the parties. So the cancellation of the contract with due regard to aspects in the law and Article 1338 paragraph (1) of the Civil Code cannot be carried out in a covid-19 pandemic force majeure situation. The parties are required to carry out good faith in accordance with Article 1338 of the Civil Code by reviewing the agreement / contract or renegotiating by adding a contract clause to postpone carrying out obligations.

317 Why Are We Cancelling Theatre Cases at Ealing Hospital? What Can Be Done?

Abstract Introduction Following a recent spate of on the day cancellation of elective operations being cancelled on the day of surgery, a need for a wider review was felt. Our aim was to identify the causes behind these cancellations. Method Retrospective data collection was performed to categorise patients according to the reason for cancellation. Analysis consisted of case presentations being prepared and presented to the surgical consultants. Results A total of 130 operations were cancelled on the day of surgery. 22 patients were cancelled due to the procedure not being required and 10 patients were cancelled due to insufficient pre-operative investigations. Analysis of the 32 cases demonstrated that the majority of cancelled patients were seen and listed for surgery after clinical review by the registrar without involvement of the consultant. Some cancellations occurred when the consultant responsible for listing the patient was different of the operating consultant. Both factors lead to differences in opinion arising on the day of surgery. Conclusions Ensuring patients are only listed after discussion with the consultant would reduce cancellations arising from lack of experience and clinical misjudgment of the registrar. It would also ensure that cases added to the pooled operating lists are less subjective in their indication and readiness.

The justification of non-obstetric ultrasound referrals: A safe and effective practice.

In 2015 the British Medical Ultrasound Society released a referral justification document for rejection of inappropriate ultrasound referrals to help manage increasing demand and ensure correct utilisation of diagnostic imaging tests. In our trust, referrals that were not aligned with the guidance were cancelled and returned to general practitioners, providing reasons for cancellation and advising other diagnostic tests if appropriate.Methodology: In total, 1000 cases cancelled between April and August 2019 were retrospectively audited by a team of clinical specialist sonographers. Interoperator agreement against BMUS justification guidelines and safety of this cancellation process were established. Duplicate imaging referrals, referrals made that should have been placed on management pathways or referrals cancelled by the patient directly were excluded in the safety assessment. There was strong agreement amongst sonographers regarding cancellations. After exclusions, 389 cases were included for review. The majority (90.5%) required no onward imaging and were therefore deemed cancelled appropriately. There were 37 patients found with pathology on subsequent imaging, two of which were found to have cancer and the remainder with benign pathology. Overall, we found the cancellation process to be safe and the justification document easy to utilise in practice. This process has ensured a minimal waiting time for ultrasound imaging is maintained and that demand can be managed to meet the available capacity.

Characteristics of helicopter emergency medical services (HEMS) dispatch cancellations during a six-year period in a Dutch HEMS region

BackgroundFor decades, Helicopter Emergency Medical Services (HEMS) contribute greatly to prehospital patient care by performing advanced medical interventions on-scene. Unnecessary dispatches, resulting in cancellations, cause these vital resources to be temporarily unavailable and generate additional costs. A previous study showed a cancellation rate of 43.5% in our trauma region. However, little recent data about cancellation rates and reasons exist, despite revision of dispatch protocols. This study examines the current cancellation rate in our trauma region over a six-year period. Additionally, cancellation reasons are evaluated per type of dispatch and initial incident report, upon which HEMS is dispatched.MethodsThis retrospective study analyzed the data of the Dutch HEMS Lifeliner 1 (North-West region of the Netherlands, covering a population of 5 million inhabitants), analyzing all subsequent cases between April 1st 2013 and April 1st 2019. Patient characteristics, type of dispatch (primary; based on dispatcher criteria versus secondary, as judged by the first ambulance team on site), initial incident report received by the EMS dispatch center, and information regarding day- or nighttime dispatches were collected. In case of cancellation, cancel rate and reason per type of dispatch and initial incident report were assessed.ResultsIn total, 18,638 dispatches were included. HEMS was canceled in 54.5% (95% CI 53.8–55.3%) of cases. The majority of canceled dispatches (76.1%) were canceled because respiratory, hemodynamic, and neurologic parameters were stable. Dispatches simultaneously activated with EMS (primary dispatch) were canceled in 58.3%, compared to 15.1% when HEMS assistance was requested by EMS based on their findings on-scene (secondary dispatch). A cancellation rate of 54.6% was found in trauma related dispatches (n = 12,148), compared to 52.2% in non-trauma related dispatches (n = 5378). Higher cancellation rates exceeding 60% were observed in the less common dispatch categories, e.g., anaphylaxis (66.3%), unknown incident report (66.0%), assault with a blunt object (64.1%), obstetrics (62.8%), and submersion (61.9%).ConclusionHEMS cancellations are increased, compared to previous research in our region. Yet, the cancellations are acceptable as the effect on HEMS’ unavailbility remains minimized. Focus should be on identifying the patient in need of HEMS care while maintaining overtriage rates low. Continuous evaluation of HEMS triage is important, and dispatch criteria should be adjusted if necessary.

Cancellation of elective surgery: rates, reasons and effect on patient satisfaction.

BackgroundThe cancellation of elective surgeries is a major problem that increases wait times, exacerbates costs and can negatively affect patients, both psychologically and physically. Our objectives were to investigate the reasons for cancellations across specialties at a single centre, to compare these reasons with previous data from the same centre between 2005 and 2009 and to examine how cancellations affected patients’ lives and views of the medical system in cases when the cancellations were potentially preventable.MethodsCancellation records of all elective surgeries scheduled between June 1, 2012, and Jan. 31, 2016, at a medium-sized, tertiary care, academic centre were retrospectively reviewed. We evaluated the rates and reasons for cancellation and interviewed a subset of patients whose surgery was cancelled for a potentially preventable reason (i.e., operating room running late, bed shortage, emergency case took place of scheduled surgery).ResultsAcross 11 surgical specialties, 2933 of 20 881 surgeries (14.0%) were cancelled and of these, 2448 (83.5%) were for administrative or structural reasons. Compared with the data collected previously for general, gynecological and urological procedures, cancellation rates increased from 8.1% to 11.8%. Although patients reported inconvenience, they were generally satisfied with the availability and the quality of the health care they received.ConclusionConsistent with the previous study, our data suggest that most cancellations occur because of administrative or structural processes that are potentially preventable. Targeting these processes may help to reduce cancellations for elective surgeries and thereby improve economic efficiency and patient outcomes.

Evaluation of the feasibility and impacts of in situ simulation in emergency medicine—a mixed-method study protocol

IntroductionIn situ simulation (ISS) consists of performing a simulation in the everyday working environment with the usual team members. The feasibility of ISS in emergency medicine is an important research...

Immediate versus postponed frozen embryo transfer after IVF/ICSI: a systematic review and meta-analysis.

In Europe, the number of frozen embryo transfer (FET) cycles is steadily increasing, now accounting for more than 190000 cycles per year. It is standard clinical practice to postpone FET for at least one menstrual cycle following a failed fresh transfer or after a freeze-all cycle. The purpose of this practice is to minimise the possible residual negative effect of ovarian stimulation on the resumption of a normal ovulatory cycle and receptivity of the endometrium. Although elective deferral of FET may unnecessarily delay time to pregnancy, immediate FET may be inefficient in a clinical setting, following an increased risk of irregular ovulatory cycles and the presence of functional cysts, increasing the risk of cycle cancellation. This review explores the impact of timing of FET in the first cycle (immediate FET) versus the second or subsequent cycle (postponed FET) following a failed fresh transfer or a freeze-all cycle on live birth rate (LBR). Secondary endpoints were implantation, pregnancy and clinical pregnancy rates (CPR) as well as miscarriage rate (MR). We searched PubMed (MEDLINE) and EMBASE databases for MeSH and Emtree terms, as well as text words related to timing of FET, up to March 2020, in English language. There were no limitations regarding year of publication or duration of follow-up. Inclusion criteria were subfertile women aged 18-46 years with any indication for treatment with IVF/ICSI. Studies on oocyte donation were excluded. All original studies were included, except for case reports, study protocols and abstracts only. Covidence, a Cochrane-tool, was used for sorting and screening of literature. Risk of bias was assessed using the Robins-I tool and the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation framework. Out of 4124 search results, 15 studies were included in the review. Studies reporting adjusted odds ratios (aOR) for LBR, CPR and MR were included in meta-analyses. All studies (n = 15) were retrospective cohort studies involving a total of 6,304 immediate FET cycles and 13,851 postponed FET cycles including 8,019 matched controls. Twelve studies of very low to moderate quality reported no difference in LBR with immediate versus postponed FET. Two studies of moderate quality reported a statistically significant increase in LBR with immediate FET and one small study of very low quality reported better LBR with postponed FET. Trends in rates of secondary outcomes followed trends in LBR regarding timing of FET. The meta-analyses showed a significant advantage of immediate FET (n =2,076) compared to postponed FET (n =3,833), with a pooled aOR of 1.20 (95% CI 1.01-1.44) for LBR and a pooled aOR of 1.22 (95% CI 1.07-1.39) for CPR. The results of this review indicate a slightly higher LBR and CPR in immediate versus postponed FET. Thus, the standard clinical practice of postponing FET for at least one menstrual cycle following a failed fresh transfer or a freeze-all cycle may not be best clinical practice. However, as only retrospective cohort studies were assessed, the presence of selection bias is apparent, and the quality of evidence thus seems low. Randomised controlled trials including data on cancellation rates and reasons for cancellation are highly needed to provide high-grade evidence regarding clinical practice and patient counselling.

Cancellations of Elective Surgeries on the Day of the Operation in a Portuguese Hospital: One Year Overview

Cancellations of elective operations on the day of the surgery reflect the efficiency and quality within organisations, and have a significant clinical, social and economic impact, not only for the patient and their families, but also for healthcare institutions. This study assesses the extent of these cancellations in one public Portuguese hospital, through case quantification and identification of the causes, origin, as well as its predictability according to the sociodemographic variables of the patient and interventions used to decrease it. Non-experimental descriptive quantitative methodology - longitudinal and retrospective - of operation cancellation cases on the day of the surgery, from the 1st of January to the 31st of December 2018. The rate of cancellations of elective surgeries on the same day of the operation was 2.9% with variations among different surgical specialties; cancelled operations are more frequent in female patients, in patients aged between 50 and 80 years old, physical status classified as II or III according to the American Society of Anesthesiology, and without anaesthetic pre assessment or preoperative consultations; the three most relevant causes for cancellations are: lack of operative time, scarcity of beds and/or medical equipment, and changes in health status; most of which can be avoided and are the responsibility of the institution. Different reasons for cancellation of elective operations reflect a variety of upstream and downstream processes causing cancellation of surgeries and whose origin/imputability is related to both the institution and patients. The rate of cancellations of elective surgeries on the same day of the operation is relatively low, but the causes are often preventable, thus justifying the generalization of cancellation reduction strategies.

Reasons for Cancellation of Elective Surgical Operations: A Cross-sectional Study from a Tertiary Care Centre in North-East India

Introduction: Cancellation of elective surgical operations is defined as an elective operation which is not performed on the scheduled date. The rates and the reasons for cancellation vary in different parts of the world. Cancellation causes increased cost of treatment, loss of daily wage and mental trauma. It also causes under utilisation of hospital resources and loss of training opportunities to surgical trainees. Aim: To estimate the rate of cancellation of elective surgical operations in a tertiary care centre in North-East India and determine the reasons for cancellation. Materials and Methods: A prospective cross-sectional study was conducted at a 500 bedded, North-Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India, from January 2018 to September 2018. All consecutive elective surgical cases scheduled during this period were included in the study. The rate and the reasons for cancellation were noted. Descriptive statistics was used for analysis of the results. Results: Out of 1812 elective surgical operations scheduled during the study period, 491 operations (27.10%) were cancelled. The most common reasons for cancellation were shortage of time (78.62%), medical causes (10.79%) and administrative problems (4.48%). Cancellation rate was highest in the Department of Surgical Oncology (40.23%), followed by Departments of Orthopaedics (34.51%) and Obstetrics and Gynaecology (OG) (31.02%). Conclusion: The rate of cancellation of elective surgical operation was high (27.10%) and the most common reason was shortage of time and Surgical Oncology Department had highest rate of cancellation.

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.