Day of Surgery Admission in Total Joint Arthroplasty: Why Are Surgeries Cancelled? An Analysis of 3195 Planned Procedures and 114 Cancellations

Abstract

Background. Day of surgery admission (DOSA) is becoming standard practice as a means of reducing cost in total joint arthroplasty. Aims. The aim of our study was to audit the use of DOSA in a specialty hospital and identify reasons for cancellation. Methods. A retrospective study of patients presenting for hip or knee arthroplasty between 2008 and 2013 was performed. All patients were assessed at the preoperative assessment clinic (PAC). Results. Of 3195 patients deemed fit for surgery, 114 patients (3.5%) had their surgery cancelled. Ninety-two cancellations (80%) were due to the patient being deemed medically unsuitable for surgery by the anaesthetist. Cardiac disease was the most common reason for cancellation (n = 27), followed by pulmonary disease (n = 22). 77 patients (67.5%) had their operation rescheduled and successfully performed in our institution at a later date. Conclusion. DOSA is associated with a low rate of cancellations on the day of surgery. Patients with cardiorespiratory comorbidities are at greatest risk of cancellation.

Factors for Postponement or Cancellation of Operating Programs Set in the Orthopedics-Traumatology Department of Yalgado Ouédraogo University Teaching Hospital in Ouagadougou (Burkina Faso)

“…From the point of view of socio-demographic characteristics, these are young patients with an average age of 40.1 years, which is similar to other African series and is explained by the youth of the population of the continent [4] [14] [15]. On the other hand, in developed countries, this average age is higher: 73 years for Dalton [8] in Ireland, and 61.5 years for Hori [11] in Japan. The sex ratio was 2.4 and is explained by the strong involvement of men in trauma.…”

“…These causes are preventable in most cases [17] [18]. If in developed countries, postponements and cancellations are increasingly rare due to better organization of services [8] [11] [16] [19], in Africa, there are still high rates that vary between 23% and 40% [9] [18] [15]. In Burkina Faso, the phenomenon seems even more accentuated with rates reaching 46% [14].…”

Cancelled total hip arthroplasty and knee arthroplasty: a retrospective analysis of 1003 patients

“…It is reported that the number of arthroplasties will increase dramatically in the coming period [4,5]. However, unexpected cancellation of scheduled TJA surgery is an unavoidable part of orthopedic practice [6,7]. The number of cancelled cases will also increase accordingly without available precautions.…”

“…Unnecessarily postponing a TJA surgery will not only worsen their suffering but could potentially affect the ultimate outcome [9,[13][14][15][16]. Meanwhile, the delay in the procedure itself or the fact that patients have another emerging medical problem to worry about can further contribute to their anxiety and depression [7,8,12,17].…”

Impact of a same day admission project in reducing the preoperative bed occupancy demand in a pediatric inpatient hospital

“…This study aimed to determine the benefits of adopting SDA, a process whereby elective surgical patients are admitted to the hospital on the day of their planned surgery [ [16] , [17] , [18] ]. SDA (also known as day of surgery admission [ DOSA]) it has been adopted globally and used for decades as a model to reduce the average length of stay and costs associated with surgery [ 19 ]. Many developed countries have introduced SDA as a part of their quality improvement projects for pediatric patients [ [20] , [21] , [22] ].…”