Contributing factors of elective surgical case cancellation: a retrospective cross-sectional study at a single-site hospital

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Abstract

Background

Case cancellation (CC) has significant impact on the efficiency of operating room (OR) management, which can be mitigated by taking preventive measures. In this study, using the data of the West China Hospital (WCH), we identified the effect of contributing factors and recommended hospital interventions to facilitate CC prevention.

Method

We conducted a retrospective review of 11,331 elective surgical cases from January 1 to December 31, 2014. CC reasons were grouped into six categories. The methods of descriptive statistics and hypothesis test were used to identify the effect of factors.

Results

CC reasons (746) were divided into six broad categories: workup related (preoperative diagnostic assessment issues or sudden medical condition changes) (25.8%), non-specified reasons (25.8%), coordination issues (15.1%), patient related (13.0%), support system issues (11.8%), and doctor related (8.5%). The types of the most frequently performed operations are identified, as well as their CRs. The cancellation rate (CR) of males was lower than that of females (16.7% to 18.3%). A large difference in the CRs existed among doctors. The CR on Monday was significantly higher than the other four weekdays.

Conclusions

Workup related issues, the types of procedures, the menstrual cycle of females, highly imbalanced CRs among doctors, and tendency of cancellation on Monday are the major identified factors, which account for a significant amount of preventable cancellations. It is suggested that corresponding hospital interventions can reduce CR and improve OR efficiency, including maintaining effective coordination, good communication and well-designed preoperative assessment processes, focusing on the type of procedures which are more time-consuming and complex, paying special attention to the physiology of females during surgery planning, taking measures to reduce CR of top eight doctors, and improving surgery scheduling on Monday.

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Most cited references 20

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Preoperative clinic visits reduce operating room cancellations and delays.

Dezheng Huo, G A Tung, B J Sweitzer … (2005)

Anesthesiologist-directed preoperative medicine clinics are used to prepare patients for the administration of anesthesia and surgery. Studies have shown that such a clinic reduces preoperative testing and consults, but few studies have examined the impact of the clinic on the day of surgery. The authors tested whether a visit to an anesthesia preoperative medicine clinic (APMC) would reduce day-of-surgery case cancellations and/or case delays. The authors conducted a retrospective chart review of all surgical cases during a 6-month period at the University of Chicago Hospitals. Case cancellations and rates of first-start case delay over the 6-month period were cross-referenced with a database of APMC attendees in both the general operating rooms and the same-day surgery suite. The impact of a clinic visit on case cancellation and delay in both sites were analyzed separately. A total of 6,524 eligible cases were included. In the same-day surgery suite, 98 of 1,164 (8.4%) APMC-evaluated patients were cancelled, as compared with 366 of 2,252 (16.2%) in the non-APMC group (P < 0.001). In the general operating rooms, 87 of 1,631 (5.3%) APMC-evaluated patients were cancelled, as compared with 192 of 1,477 (13.0%) patients without a clinic visit (P < 0.001). For both operating areas, APMC patients had a significantly earlier room entry time than patients not evaluated in the APMC. An evaluation in the APMC can significantly impact case cancellations and delays on the day of surgery.

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Elective surgical case cancellation in the Veterans Health Administration system: identifying areas for improvement.

Mary Hawn, Sarah Vick, Jennifer Argo … (2009)

This study evaluated elective surgical case cancellation (CC) rates, reasons for these cancellations, and identified areas for improvement within the Veterans Health Administration (VA) system. CC data for 2006 were collected from the scheduling software for 123 VA facilities. Surveys were distributed to 40 facilities (10 highest and 10 lowest CC rates for high- and low-volume facilities). CC reasons were standardized and piloted at 5 facilities. Of 329,784 cases scheduled by 9 surgical specialties, 40,988 (12.4%) were cancelled. CC reasons (9,528) were placed into 6 broad categories: patient (35%), work-up/medical condition change (28%), facility (20%), surgeon (8%), anesthesia (1%), and miscellaneous (8%). Survey results show areas for improvement at the facility level and a standardized list of 28 CC reasons was comprehensive. Interventions that decrease cancellations caused by patient factors, inadequate work-up, and facility factors are needed to reduce overall elective surgical case cancellations.

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The effect of outpatient preoperative evaluation of hospital inpatients on cancellation of surgery and length of hospital stay.

Wilton van Klei, Karel Moons, Charles Rutten … (2002)

To evaluate the possible effects of outpatient preoperative evaluation (OPE) for new surgical patients who will be inpatients, we conducted an observational study at a university hospital in The Netherlands. Various outcomes before and after the introduction of an OPE clinic were compared. The study population comprised all 21,553 elective adult inpatients operated on between January 1, 1997 and December 31, 1999. Cardiac surgery, obstetric and pediatric patients, and patients operated on in same-day surgery were excluded. The main outcome measures were surgical cases canceled for medical reasons, rate of same-day admissions (who were expected to increase), and length of hospital stay. After introduction of OPE, the rate of cancellations for medical reasons decreased from 2.0% to 0.9% (adjusted odds ratio 0.7, 95% CI, 0.5--0.9). The rate of same-day admissions increased from 5.3% before to 7.7% after OPE introduction (adjusted odds ratio 1.2, 95% CI, 1.01--1.39), and the total hospital length of stay (in days) significantly decreased by a factor of 0.92 (0.90--0.94), which was partly the result of a reduction in preoperative admission time. We concluded that, although smaller than anticipated, the use of OPE for potential inpatients leads to a significant reduction of cancelled cases and of length of admission. Further increase of these benefits from OPE requires changes in institutional policy, such as forcing surgical departments to increase their number of same-day admissions. An observational study was conducted to compare various outcomes before and after the introduction of outpatient preoperative evaluation (OPE). Although smaller than anticipated, OPE for potential inpatients leads to a significant reduction of canceled cases and of length of admission.

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Author and article information

Contributors

Kaiye Yu: yannisyu007@163.com

Xiaolei Xie: xxie@tsinghua.edu.cn

Li Luo: luolicc@163.com

Renrong Gong: 285798772@qq.com

Journal

Journal ID (nlm-ta): BMC Surg

Journal ID (iso-abbrev): BMC Surg

Title: BMC Surgery

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2482

Publication date (Electronic): 11 September 2017

Publication date PMC-release: 11 September 2017

Publication date Collection: 2017

Volume: 17

Electronic Location Identifier: 100

Affiliations

[1 ]ISNI 0000 0001 0662 3178, GRID grid.12527.33, Department of Industrial Engineering, , Tsinghua University, ; Beijing, China

[2 ]ISNI 0000 0001 0662 3178, GRID grid.12527.33, Department of Industrial Engineering, , Tsinghua University, ; Beijing, China

[3 ]ISNI 0000 0001 0807 1581, GRID grid.13291.38, Department of Industrial Engineering and Engineering Management, Service Management Institute, , Business School of Sichuan University, ; Chengdu, China

[4 ]ISNI 0000 0001 0807 1581, GRID grid.13291.38, Operating Room Department, West China Hospital, , Sichuan University, ; Chengdu, China

Article

Publisher ID: 296

DOI: 10.1186/s12893-017-0296-9

PMC ID: 5594612

PubMed ID: 28893218

SO-VID: e17c4573-86cb-4ec0-a296-6e70caccfe7d

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 13 April 2017

Date accepted : 5 September 2017

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;

Award ID: 71501109

Award ID: 71131006

Award ID: 71532007

Award Recipient : Xiaolei Xie Li Luo

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ScienceOpen disciplines: Surgery

Keywords: case cancellation,contributing factors,operating room efficiency,quality improvement

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ScienceOpen disciplines: Surgery

Keywords: case cancellation, contributing factors, operating room efficiency, quality improvement

Contributing factors of elective surgical case cancellation: a retrospective cross-sectional study at a single-site hospital

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SICOT-J (Orthopedic surgery and traumatology)

Most cited references 20

Preoperative clinic visits reduce operating room cancellations and delays.

Elective surgical case cancellation in the Veterans Health Administration system: identifying areas for improvement.

The effect of outpatient preoperative evaluation of hospital inpatients on cancellation of surgery and length of hospital stay.

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