Major factors influencing operating day cancellation of surgical cases in a tertiary hospital

Abstract

Aim/Background: Most hospitals dedicate a considerable fraction of their budget in maintaining operating suites. This includes the provisions of consumables, personnel and logistics. Cancellation of elective surgical patients decreases efficiency, increases cost, duplication of workload, operating room time wastage and disruption of daily life. The remote causes and rate of cancellation are unknown. This study evaluated the rate, reasons and pattern of cancellation on the day of surgery.

Methods: The records of the operating room theatre of the University of Benin Teaching Hospital, Nigeria were reviewed for a 5-year period (June 2010 – May 2014). The records were further scrutinized to identify all scheduled elective procedures, the procedures that were actually performed, those that were cancelled, the reasons for cancellation and the surgical specialty. The cancelled cases were evaluated to define the reasons and rate of cancellation.

Results: A total of 10005 patients where scheduled for elective procedure. Nine thousand one hundred and sixty eight (9,168) were performed and 837 were cancelled (8.4%) within the study period. The paediatric age group has the highest cancelled cases, particularly the under 10year of age (27.5%). Patient related factors were the major reasons for cancellation. Failure to present for surgery (No show) was the leading patient related factor. Burns and Plastic Unit, Paediatric Surgery, Orthopaedics and Maxillofacial Unit have 3 fold risk of cancellation when compared to General Surgery while Trauma, Neurosurgery, ENT and Gynaecological Unit had the lowest chance of cancellation (RR < 1.0). No show, no operating room time and surgeon cancellation accounts for 43% of the cancelled cases.

Conclusion: The evaluation of reasons for cancellation on the day of surgery shows a rate of 8.4%. Poor scheduling comprising no show (absentee patient), no operating time and surgeon’s cancellation were the main identifiable risk factors.