Outcomes and Disposition of Patients After Case Cancellation on Day of Surgery for Reasons Attributed to Medical or Anesthetic Care: A Retrospective Cohort Analysis

Abstract

BACKGROUND: Many day-of-surgery cancellations are avoidable, and different strategies are used to prevent these costly adverse events. Despite these past analyses and evaluations of positive interventions, studies have not examined the final disposition of patients whose cases were canceled in this late manner. This study sought to determine whether surgical procedures canceled for medical or anesthetic reasons were ultimately rescheduled, and the time elapsed between cancellation and completion. In addition, the resolution of the underlying issue leading to cancellation was examined. METHODS: Two years of surgical case data were reviewed in the electronic health record to isolate all procedures canceled on the intended operative date. These cases were then filtered by the documented reason for cancellation into 2 categories: 1 for cases related to medical or anesthetic care and 1 for unrelated cases. Medical- or anesthetic-related cases were further categorized to better elucidate the underlying reason for cancellation. Cases were then traced to determine if and when the procedure was ultimately completed. If a case was rescheduled, the record was reviewed to determine whether the underlying reason for cancellation was resolved. RESULTS: A total of 4472 cases were canceled in the study period with only 20% associated with medical or anesthetic causes. Of these, 72% were rescheduled and 83% of all rescheduled cases resolved the underlying issue before the rescheduled procedure. Nearly half of all cases (47.8%) canceled on the day of surgery for reasons linked to medical and/or anesthetic care were due to acute conditions. CONCLUSIONS: Nearly a fifth of cases that are canceled on the date of surgery are never rescheduled and, if they are rescheduled, the delay can be substantial. Although the majority of patients whose procedure are canceled for reasons related to medical or anesthetic care have resolved the underlying issue that led to initial postponement, a significant portion of patients have no change in their status before the ultimate completion of their surgical procedure.

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

“… 2 , 3 , 4 , 5 , 7 , 19 , 20 The characteristics of patients, hospital facilities, medical and administrative staff, and the socioeconomic status of patient populations have been cited as the primary components of patient-related, facility-related, and surgery-related causes resulting in surgery cancellations. 21 We did not use such stratifications due to the narrower focus of the study, which addressed only the cancellations made once the patient was taken to the operating room. Becker et al 22 investigated the non-medical risk factors that lead to postponing elective surgeries.…”

The effect of a bundle intervention for ambulatory otorhinolaryngology procedures on same‐day case cancellation rate and associated costs

“…There is a substantial global burden of surgical procedure cancellation [4][5][6][7]. In the USA, nearly one-fifth of cases that are cancelled on the day of surgery are never rescheduled and, if they are, the delay can be substantial [8]. Estimated lost revenue for cancelled elective surgery is $5000-8000 (£3955-6327; €4608-7373) per case, depending on the type of surgery and admission status [9][10][11].…”

Preoperative GLP-1 Receptor Agonist Use and Risk of Postoperative Respiratory Complications

“…3 Furthermore, associated logistical burdens can result in surgical cancellations, significant care delays, and financial losses from unused operating room time. 4,5 These downsides are pronounced for GLP-1 RAs due to recommended withholding periods of up to a week. Given increasing use of GLP-1 RAs, larger-scale evaluations of their perioperative risks are needed; however, a randomized trial of preoperative GLP-1 RA withholding may not be feasible.…”

“…Although preoperative medication guidelines can prevent complications, withholding medications can also result in adverse effects . Furthermore, associated logistical burdens can result in surgical cancellations, significant care delays, and financial losses from unused operating room time . These downsides are pronounced for GLP-1 RAs due to recommended withholding periods of up to a week.…”