The Burden of On Day Surgery Cancellations in a Quaternary Care Hospital – Dr Ashitha Vijayan

Considerable resources are invested in maintaining a well-functioning operating theatre. Cancellation of elective scheduled operations leads to an inefficient use of operating room time and a waste of resources. Cancellation is a major problem in most hospitals. Elective surgical case cancellation refers to any surgical case that is booked into the operation theatre list on the day prior to surgery but is not operated upon as scheduled. The reasons for cancellation of elective surgical cases are many; they are as unique as they are similar. The study aims to assess the magnitude of elective case cancellation and delineate the reasons for elective case cancellations across all surgical departments. The study aims to suggest necessary steps to alleviate the problem.
A prospective study was done from 2nd January 2020 to 19th March 2020 at a quaternary care hospital. All elective surgeries scheduled during the period were taken into study. The cancellations on day of surgery were recorded and the reasons for these cancellations were obtained from the Patient Financial Counsellors.
The reasons were categorized as potentially avoidable and unavoidable, as well as hospital related and patient related reasons. The collected data was analysed and a pareto analysis was done to identify the major contributing factor for potentially avoidable cancellations.
Out of 3998 elective surgeries, 534 surgeries were cancelled (13.3%). The major reason for cancellation was clinical reasons (22%) followed by bookings with incorrect details(16%), non-affordability (14%), postponed due to delay in insurance approval (12%), postponed due to personal reason (12%), patient not willing for surgery (12%), patient not responding to calls (7%), surgery done in other hospital (2%), cancelled due to clinical reason (2%), wants to take second opinion (1%) and medical management, unavailability of OT, unavailability of surgeon each at 0%. Cancellation was highest with Orthopaedics (20%), ENT (16%), Urology and Oncology with 13% each. The pareto analysis reveals that 80% of cancellations were due to bookings with incorrect details, non-affordability, postponed due to delay in insurance approval, postponed due to personal reasons and patient not willing for surgery. Appropriate interventions focusing on the major contributors for cancellations will help reduce the on day surgical cancellation rates.