Surgical Cancellations Research Articles

Predicting Elective Orthopaedic Sports Medicine Surgical Cancellations Based on Patient Demographics

PurposeTo evaluate whether patient demographics are associated with cancellation of elective orthopaedic sports medicine surgical procedures.MethodsWe retrospectively reviewed the electronic medical records of 761 patients who were scheduled to undergo an elective sports medicine orthopaedic operation from January 1, 2015, to December 31, 2017. The patients were divided into 2 groups: those who underwent the scheduled procedure (group A) and those in whom the operation was canceled for any reason prior to the surgical date and not rescheduled (group B). Univariate analysis assessed patient factors consisting of age, sex, race, language, marital status, occupation status, type of insurance (Medicaid or Medicare vs private), smoking history, employment status, and history of surgery to determine which demographic factors led to an increased risk of elective case cancellation.ResultsPatients who canceled were significantly older (46.5 years vs 41.5 years, t = 2.432, P = .015) than those who do not. In addition, current smokers (22.5% vs 10.9%, χ2 = 10.85, P = .001), patients with Medicare or Medicaid versus private insurance (16.7% vs 10.0%, χ2 = 5.35, P = .021), non–English-speaking patients (29.5% vs 11.6%, χ2 = 11.43, P = .001), and patients without a history of surgery requiring anesthesia (18.8% vs 9.6%, χ2 = 9.96, P = .002) were all more likely to cancel. When all studied variables were examined in a logistic regression analysis, of the above demographic variables, only insurance status was no longer significant, given its correlation with age and language.ConclusionsIncreased age (≥46.5 years), non-English speaking, smoking, lack of a history of surgery requiring anesthesia, and Medicaid or Medicare insurance were found to contribute to an increased risk of elective orthopaedic surgery cancellation.Level of EvidenceLevel III, case-control study.

Designing a cost-driven mechanism to reduce cancellation of elective surgeries

BackgroundA significant portion of each country's budget is assigned to its health care system annually. Given the current economic conditions, saving costs is a key issue. Therefore, any situation that leads to lower efficiency and higher costs should be remedied. With much of the hospitals' budgets spent on operating rooms, it is important to use strategies to increase their efficiency and quality. The purpose of this study is to design a mechanism to reduce the cancellation of elective surgical procedures, which incurs considerable costs. MethodsTo this end, the data gathered from an educational hospital in Tehran were evaluated. The reasons for the surgical cancellations were determined through data analysis and process identification. Subsequently, considering the contents of the current literature and consultations with the hospital staff, suggestions were made to reduce surgical cancellations. Finally, using a solution allocation model, the best solution in terms of costs, efficiency, and implementation time was assigned by using the Fuzzy Extended Analytical Hierarchy Process to each of the reasons and surgeries. ResultsBy solving the allocation model using the GAMs software, the solutions were assigned to specific reasons and surgeries. This solved model assigns the best solutions to cancellation reasons regarding solutions cost, efficiency and implementation time. ConclusionsThe cancellation of the six investigated surgeries alone imposes on the hospital approximately 1165,653,450 rials annually, so it is true to assume that, in general, reducing the cancellation of surgery can reduce hospital costs considerably.

Avaliação dos fatores de cancelamento de cirurgias em hospitais do nordeste brasileiro

Objetivos: Identificar a taxa de cancelamento cirúrgico e avaliar os fatores que causam o cancelamento de cirurgias. Método: Pesquisa quantitativa realizada nos centros cirúrgicos de dois hospitais de grande porte do Nordeste brasileiro, sendo um público e o outro privado-público. A pesquisa foi aprovada pelo Comitê de Ética, sob Certificado de Apresentação para Apreciação Ética (CAAE) 46831515.6.0000.5013, e a coleta dos dados foi realizada por meio do banco de dados eletrônico dos hospitais. Resultados: No período de janeiro de 2014 a dezembro de 2015, no hospital privado-público, foram programadas 20.810 cirurgias e suspensas 4.815, com taxa de suspensão cirúrgica de 23,3%. No hospital público, foram programadas 6.392 cirurgias e suspensas 2.702, com taxa de suspensão de 42,7%. Os principais fatores de suspensão relacionaram-se ao paciente e a aspectos administrativos. Conclusão: Foi possível identificar aumento da incidência de cancelamentos cirúrgicos no decorrer dos anos, evidenciando taxas de suspensão consideráveis. Dessa forma, é preciso que as instituições busquem estratégias com a finalidade de minimizar a incidência de cancelamentos de procedimentos anestésico-cirúrgicos nas instituições de saúde

Efficient operating room planning using an ensemble learning approach to predict surgery cancellations

Cancelled surgeries cause insufficient use of operating rooms, surgeons, nurses, equipment and other hospital resources. Operating rooms are one of the most expensive resources in any healthcare system. The average amount of cost for any operating room for a less complex procedure is around $29/min, while the more complex procedures cost up to $80/min. Many studies have been conducted to analyze and understand the reasons behind surgery cancellation; however, a handful of studies aimed to predict which patients have a large risk of cancellation. We used four different traditional data mining techniques—Conditional Inference Tree, C5.0, logistic regression, and Radial Basis Function Kernel Support Vector Machine—to predict surgical cancellations to create efficient surgical patients’ schedules. Then, a stacking generalization ensemble machine was developed and compared to the traditional methods. Three different scheduling scenarios were developed and tested using discrete event simulation (DES). The stacking generalization ensemble machine outperformed all traditional data mining techniques and the benchmark algorithm with an accuracy of 95% and area under the curve (AUC) of 96%. The proposed simulation-based optimization scheduling technique increased the operating room use by 13%. Surgeries cancellation prediction leads to efficient scheduling that ultimately leads to reductions in expenditure.Highlights:Created a robust framework to increase OR utilizationPredicted surgery cancellation using data mining approachesCreated a novel stacking ensemble machineEnhanced the prediction power through ensemble learning that outperformed the other algorithmsDetermined overbooking opportunities through Simulation-based optimization

Cancellation of Surgeries by the Patient, Doctor or Institution: An Approach to Legal Ethical Aspects

INTRODUCTION: The cancellation of surgery represents a dilemma in establishing relatively adequate cancellation rates according to the factor, because each institution and surgical specialty have different dynamics. Objective: Describe the types of factors present for the cancellation of surgeries in a health institution. Colombia (2017-2018).
 
 METHODOLOGY: Descriptive, retrospective, cross-sectional study. We reviewed (3339) records of scheduled surgeries from January to December 2017. In 2018 they were reviewed (1733) between January and June. A total of (5072) records of a Third Level Health Institution of the Department of Cesar / Colombia were reviewed. The Neuronal Multilayer Perceptron Network model and the Gini coefficient were applied to determine the most important factor and therefore the inequality between them. 
 
 RESULTS: In 2017, there was a surgical cancellation rate of 4% of the total number of scheduled surgeries (3339). For the year 2018, the rate was 3% of the total of scheduled surgeries (1733). The most important factor was due to the patient's adverse conditions. The surgical specialties that had the highest number of cancellations were general surgery followed by orthopedics. 
 
 CONCLUSION: An evaluation of the factors for the cancellation of programmed surgeries with a high coefficient of inequality is described. In addition, the most important factor was related to the patient. Prospective studies by specialty are proposed for the design of solution and monitoring strategies to avoid surgical cancellations.

Reducing Preventable Surgical Cancellations: Improving the Preoperative Anesthesia Interview Process

Thorough and accurate preoperative anesthesia interviews may help improve perioperative efficiency by reducing unnecessary preoperative testing and preventable surgical cancellations, both of which create financial burdens. Standardized anesthesia preoperative interview guidelines and online educational modules for registered nurses (RNs) conducting preoperative interviews may improve this process. Predesign and postdesign, retrospective chart review. Online educational modules and standardized preoperative anesthesia interview guidelines were developed for RNs conducting preoperative interviews. A retrospective chart review compared preoperative anesthesia interview record completion rates, compliance with laboratory testing, and the total number of preventable surgical cancellations. Documentation of preoperative anesthesia interview records increased, whereas unnecessary preoperative testing decreased, neither with statistical significance. Preventable cancellation rates decreased significantly from 34.3% to 20% (P < .5) contributing to a 3-month postimplementation cost savings of approximately $30,000. A standardized preoperative anesthesia interview guideline and online anesthesia educational modules for RNs conducting preoperative anesthesia interviews improved preoperative record completion rates, reduced unnecessary laboratory testing, and averted surgical cancellations.

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

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

Effect of a Mobile App on Preoperative Patient Preparation for Major Ambulatory Surgery: Protocol for a Randomized Controlled Trial

BackgroundInadequate preoperative patient preparation causes organizational, economic, and emotional problems to patients and professionals. In Spain, no current evidence is available on either the rate of compliance or the impact of good compliance with preoperative recommendations by patients in the ambulatory setting. However, it is known that around 25% of surgical cancellations in the major ambulatory surgery (MAS) are due to poor compliance with these recommendations and, therefore, avoidable. Introducing innovative tools based on mobile health (mHealth) apps may help patients meet the preoperative recommendations and, consequently, reduce the rate of cancellations in the ambulatory setting.ObjectiveThe objective of this study was to evaluate the effectiveness of the Listeo+ mHealth app as a tool for improving compliance with preoperative recommendations in MAS versus standard of care (SOC).MethodsA multicenter, randomized, open-label clinical trial that compares SOC with the additional use of Listeo+, a specific mHealth app for MAS preoperative patient monitoring, is being conducted. The study will include patients aged ≥18 years with surgical indication for MAS who meet the necessary technological and connectivity requirements. Patients in the control group will receive written preoperative recommendations, while those in the intervention group will additionally use the Listeo+ mHealth app. There will be a competitive recruitment of 790 patients during 6 months in 4 hospitals in Andalusia (Spain) that belong to the National Health System. The primary efficacy outcome is the level of compliance with preoperative recommendations. Secondary outcomes include the rate of cancellations, associated resource consumption, and perceived usability and utility with Listeo+ by participants of the intervention group. Simple randomization 1:1 procedure will be used to allocate patients to each study group.ResultsThe technological development of Listeo+ and the integration and interoperability of information systems was completed in September 2017. Subsequently, simulation tests were performed with Listeo+, and a pilot study was initiated with real patients that concluded successfully in October 2017. Patient recruitment began in December 2017 in the 4 participating centers. After an intermediate analysis performed 10 months after the start of the recruitment phase, the data collection and cleaning phases are estimated to be completed in April 2019, and the analysis with the final results will be conducted in July 2019.ConclusionsProgress in the integration and interoperability of information systems represents a major step forward in the field of mHealth. The app will allow health professionals to monitor in real-time patients’ preparation and critical preoperative recommendations fulfillment. We expect a reduction in avoidable preoperative cancellations due to a lack of or a poor patient preparation. Self-assessed Web-based questionnaires and focus group will provide important information about the perceived usability and utility of Listeo+ app among patients and health care professionals.International Registered Report Identifier (IRRID)DERR1-10.2196/10938

Prioritizing Surgical Cancellation Factors Based on a Fuzzy Best-Worst Method: A Case Study

Abstract Surgery is a potent source of income, and surgical cancellation is a significant issue for hospitals. Surgical cancellation costs a lot to both patients and hospitals. Reducing a surgical cancellation rate has a substantial effect on improving hospital management. This paper considers both the effects of surgical cancellation on patients and hospitals. In addition, it presents a fuzzy best-worst method (BWM) based on a failure mode and effect analysis (FMEA) method to evaluate surgical cancellation factors. To achieve this aim, the FMEA and three effective criteria are taken into consideration. The psychological impact of surgical cancellation is one of the effective criteria, which has never considered as the involved criterion. Finally, a real case study in a Shariati hospital in Tehran is conducted to demonstrate the application of the proposed method.

Analysis of 24-hour surgical cancellations in an academic rhinology and skull base surgery practice.

Late cancellations within 24 hours of surgery lead to decreased utilization of operating room time with loss of productivity, decreased access to care, and inconvenience to patients and staff. To date, no studies have analyzed 24-hour cancellations in a tertiary rhinology practice. All procedures performed at a tertiary rhinology/skull base practice from January 2016 to December 2017 were reviewed. Twenty-four-hour cancellations were analyzed by procedure type and reason for cancellation. Avoidable cancellations were late cancellations that could have been prevented by review of medical records or communication by hospital staff with the patient before surgery. Univariate analysis was performed to determine predictive factors for cancellations. A total of 39 of 640 surgical cases were cancelled (6.1%) within 24 hours of surgery. Of these, 69.2% were inflammatory and 30.8% were skull base cases. The mean number of operating room minutes lost was 151 (60 of 210) for inflammatory and 263 (102 of 480) for skull base cases. Avoidable cancellations were seen in 25 of 35 (71.4%) cases. Patients undergoing inpatient or skull base surgery were more likely to have medical cancellations than patients undergoing outpatient or inflammatory surgery (91.7% vs 43.5%, p = 0.01; 83.3% vs 47.8%, p = 0.07). This is the first study to analyze 24-hour cancellations in tertiary rhinology/skull base surgery. The results suggest that a majority of late cancellations are avoidable and that skull base and inpatient surgeries are more likely to be canceled for medical reasons. Further studies are required to better characterize surgical cancellations in rhinology and identify strategies to try to prevent them.

Elective Surgical Cancellations in a Tertiary Hospital in the Middle East: Quality Improvement Process

Cancellation of elective surgery negatively affects patient outcomes and the efficiency of the work environment. The purpose of this project was to analyze the cancellation of elective surgeries and identify the best evidence-based interventions to address cancellations in a tertiary hospital in the Middle East. A quality improvement study design. A retrospective review of cancellations conducted over two 3-month periods in 2016 and2017. In both phases of the audit, patient-related reasons were the leading cause of cancellations. Conducting a preoperative call 2days before surgery and doing a weekly review of the surgery schedule reduced cancellations from 3.8% to 3.5%. Cancellations because of patient-related reasons reduced from 81% to 79.7% whereas cancellations because of hospital-related reasons reduced from 17.5% to 15.9%. Cancellation of surgeries is a worldwide health care issue and without understanding the causes of cancellations, it is difficult to devise an effective intervention to address this issue.

Cancelled operations: a 7-day cohort study of planned adult inpatient surgery in 245 UK National Health Service hospitals

BackgroundCancellation of planned surgery impacts substantially on patients and health systems. This study describes the incidence and reasons for cancellation of inpatient surgery in the UK NHS. MethodsWe conducted a prospective observational cohort study over 7 consecutive days in March 2017 in 245 NHS hospitals. Occurrences and reasons for previous surgical cancellations were recorded. Using multilevel logistic regression, we identified patient- and hospital-level factors associated with cancellation due to inadequate bed capacity. ResultsWe analysed data from 14 936 patients undergoing planned surgery. A total of 1499 patients (10.0%) reported previous cancellation for the same procedure; contemporaneous hospital census data indicated that 13.9% patients attending inpatient operations were cancelled on the day of surgery. Non-clinical reasons, predominantly inadequate bed capacity, accounted for a large proportion of previous cancellations. Independent risk factors for cancellation due to inadequate bed capacity included requirement for postoperative critical care [odds ratio (OR)=2.92; 95% confidence interval (CI), 2.12–4.02; P<0.001] and the presence of an emergency department in the treating hospital (OR=4.18; 95% CI, 2.22–7.89; P<0.001). Patients undergoing cancer surgery (OR=0.32; 95% CI, 0.22–0.46; P<0.001), obstetric procedures (OR=0.17; 95% CI, 0.08–0.32; P<0.001), and expedited surgery (OR=0.39; 95% CI, 0.27–0.56; P<0.001) were less likely to be cancelled. ConclusionsA significant proportion of patients presenting for surgery have experienced a previous cancellation for the same procedure. Cancer surgery is relatively protected, but bed capacity, including postoperative critical care requirements, are significant risk factors for previous cancellations.

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

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

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

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

Cancelación de procedimientos electivos y su relación con la valoración preanestésica

&#x0D; Introducción: la cancelación de los procedimientos quirúrgicos obedece en ocasiones a una valoración preanestésica incompleta. En la actualidad no se conocen estudios en Colombia que hayan evaluado este proceso. Objetivo: describir las causas de cancelación de cirugía electiva y analizar su relación con la valoración preanestésica durante un mes en un hospital de cuarto nivel en la ciudad de Bogotá. Materiales y métodos: estudio observacional de tipo corte transversal donde se describe la frecuencia de cancelaciones de cirugía electiva y las variables relacionadas con la valoración preanestésica. Resultados: se revisaron 848 evaluaciones de pacientes programados para cirugía electiva; 59.8% fueron mujeres, el promedio de edad fue de 46.3±18.8 y 45.3±21.4 años para mujeres y hombres respectivamente. El 46.3% de los pacientes se clasificó en riesgo anestésico ASA I y el 45.9% en ASA II. La incidencia de cancelación de cirugías programadas fue de 5.9% (n=50), de las cuales 18% (n=9) correspondió a causas anestésicas. Conclusión: la tasa de cancelación de procedimientos electivos es baja y no se relaciona con una causa anestésica o una valoración preanestésica deficiente.&#x0D;

Factors Associated With Late Surgical Cancellations in Pediatric Plastic and Oral Surgery.

Surgical cancellations that occur within 1 day of the procedure (ie, late cancellations) disrupt the efficiency of the operating room. The aim of the present study was to identify the factors associated with late cancellations in a tertiary pediatric surgical practice. We reviewed the medical records of patients treated by plastic and oral surgery services at our institution from 2010 to 2015. We collected data pertaining to the timing and reasons for cancellation. Reasons for cancellation were retrospectively classified by the investigators as either "preventable," "possibly preventable," "unpreventable," or "undocumented." We also measured the frequency of cancellations based on type of surgery. Of 10,730 scheduled operating room cases, 444 (4.1%) were cancelled within 24 hours of the procedure. Sixty-seven percent (297/444 cases) were cancelled on the same day as the planned procedure, and the remaining cases were cancelled the day prior after 1 PM. Forty-two percent of cancellations were deemed preventable, and 45.3% of cases were deemed possibly preventable. The majority of procedures were cancelled because of illness (44%), inadequate fasting (9%), and parental inconvenience (7%). The highest frequency of cancellation was found in skin lesion (36%) followed by dentoalveolar (14%) and cleft lip and palate (12%) cases. In our study, most late surgical cancellations were preventable or possibly preventable. The timing of the cancellation is important because those that occur near the scheduled procedure time disallow adequate and timely redistribution of operating room resources and personnel. Analyzing and addressing the preventable and possibly preventable causes outlined in this study will significantly improve efficiency and patient access.

Preoperative anesthesia evaluation

The preoperative evaluation is the first step in ensuring the safe conduct of anesthetic care in pediatric patients of all ages. Over time, this process has changed significantly from a time when patients were admitted to the hospital the night before surgery to a time when the majority of patients, including those scheduled for major surgical procedures, arrive the day of surgery. For most patients, the preoperative examiantion can be conducted over the phone by a trained nurse or on-line via a survey thereby eliminating the need for a separate visit merely for the preoperative evaluation. Regardless of where or how it occurs, the goals of the preoperative evaluation are to gain information regarding the patient’s current status, comorbid conditions, and the intended procedure. This process allows the identification of patients who require additional preoperative testing or those patients who need to be seen by an anesthesiolgoist prior to the day of surgery. During the preopeative evalaution, decisions are made regarding further laboratory or investigative work-up that are required. The preoperative meeting provides an arena to develop the initial parent-physcian rapport, outline anesthetic risks, and discuss the intended anesthetic plan including options for postoperative analgesia. The process facilitates the care of patients during the perioperative period while limiting surgical cancellations resulting from patient-related issues. The following chapter reviews the essential components of the preoperative evaluation including the appropraite use of preoperative laboratory testing and other investigative procedures including radiologic imaging. Key components of the physical examinatino including the airway examination are reviewed.

Effectiveness of preoperative medical consultations by internal medicine physicians: a systematic review

ObjectiveClinics have been established to provide preoperative medical consultations, and enable the anaesthetist and surgeon to deliver the best surgical outcome for patients. However, there is uncertainty regarding the effect...

Gastric ultrasound to guide anesthetic management in elective surgical patients non-compliant with fasting instructions: a retrospective cohort study.

Perioperative aspiration leads to significant morbidity and mortality. Standard fasting periods are used to ensure an empty stomach in patients. Anesthesiologists are frequently confronted with cases of dubious adherence to these guidelines. Point-of-care gastric ultrasound is a diagnostic tool that offers information on the type and volume of gastric contents. We performed a retrospective analysis of a departmental database containing clinical and sonographic information on elective surgical patients who had been non-compliant to the fasting guidelines. Primary outcome was the incidence of changes in aspiration risk stratification and anesthetic management when a point-of-care gastric ultrasound examination was added to a standard history-based clinical assessment. Secondary outcomes included type of changes (timing of the surgical procedure or change in anesthetic technique) and the incidence of aspiration. Differences in the management plan (history-based versus gastric ultrasound) were tested with McNemar-Bowker's Exact Test of symmetry. Thirty-seven patients met the inclusion criteria. Aspiration risk assessment and anesthetic management changed in 24 cases (64.9%) following gastric ultrasound. Additionally, there was a non-significant difference in the distribution of the pre- and post-test changes in timing (delay, cancel, proceed) (P=0.074) with a trend towards a lower number of surgical cancellations and a higher number of proceeds. No aspirations were documented. This retrospective study suggests that gastric ultrasound may be a useful diagnostic addition to standard patient assessment in cases of non-compliance to fasting guidelines. It allows to personalize aspiration risk assessment and to tailor anesthetic management to the individual patient.

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.