Last-minute cancellation of adult patients scheduled for cardiothoracic surgery in a large Dutch tertiary care centre

Abstract

OBJECTIVES Unanticipated 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. METHODS Patients 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. RESULTS A 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. CONCLUSIONS Last-minute cancellations were commonly seen in our cohort, and the reasons for cancellation were significantly related to adverse medical outcomes.

Predictors of same day cancellation of elective surgery

“…While the current study differs from those described in that we did not classify cancellations as avoidable or unavoidable, ‘other medical issues,’ ‘abnormal lab values,’ and ‘cardiac issues’ were the top three reasons for same day cancellation in our population, accounting for nearly 60% of cancellations. This is slightly higher than the proportion of medical reasons for cancellation reported in prior studies, which range from 12% to 55% of surgery cancellations, depending on the population under examination and timing of cancellations included (Kumar & Gandhi 2012, Matzek et al 2020, Rymaruk, 2011, Scheenstra et al 2021, Wong et al 2018). Furthermore, operational factors such as lack of OR availability, bed availability, financial clearance, and sterile instrumentation accounted for 9% of cancellations in the current study, compared to 30%–67% in prior studies (Kaddoum et al 2016, Rymaruk 2011).…”

“…To date, the majority of research related to cancellation of surgery has focused on reasons for cancellation (Ezike et al 2011, Kumar & Gandhi 2012, Pohlman et al 2012, Rymaruk 2011, Smith et al 2014). Reported reasons for cancellations are highly variable across studies; however, commonly reported reasons include clinical issues such as incomplete medical evaluations, lack of medical fitness for surgery, and administrative/operational issues such as lack of financial clearance, and shortcomings in operating room or inpatient bed availability (Kaddoum et al 2016, Matzek et al 2020, Rymaruk 2011, Scheenstra et al 2021, Spazzapan et al 2023). Up to 80% of cancellations have been described as potentially avoidable (Rymaruk 2011), suggesting that interventions aimed at reducing cancellations are needed to improve operational efficiency and the patient experience (Hovlid et al 2012).…”

Prevalence and Causes of Elective Surgery Cancellations After Patients are Taken to the Operating Room: A Prospective, Cross-Sectional Study

“… 6 , 8 The emotional trauma experienced by patients and their families due to surgery cancellations is another negative result. 9 , 10 Cancellation of elective surgery after the patient is taken to the operating room causes extra emotional distress in patients, in addition to unnecessary costs and ineffective use of hospital resources. 11 , 12 …”

Prevalence and Causes of Elective Surgery Cancellations after the Patients Are Taken to the Operating Room: A Prospective, Cross-Sectional Study

“…Unexpected cancellation of a surgery as late as the day the surgery is scheduled to be performed or even after the patient to be operated on is taken to the operating room has a more significant negative impact on hospital resources than cancellation of the surgery before the date it is scheduled to be performed [6,8]. The emotional trauma experienced by patients and their families due to surgery cancellations is another negative result [9,10]. Cancellation of elective surgery after the patient is taken to the operating room causes extra emotional distress in patients, in addition to unnecessary costs and ineffective use of hospital resources [11,12].…”