Cancellation of elective operations on the day of intended surgery in a Hong Kong hospital: point prevalence and reasons.

OBJECTIVE To determine the point prevalence of elective surgical case cancellations and the reasons. DESIGN Cross-sectional study. SETTING Teaching hospital, Hong Kong. PATIENTS; Operating theatre records of elective surgery cancellations from 1 January 2009 to 31 December 2009 were retrospectively reviewed. MAIN OUTCOME MEASURES. Cancellation of scheduled elective surgery on the day of surgery and the corresponding reasons. RESULTS Of 6234 cases scheduled, 476 were cancelled, which yielded a point prevalence of 7.6%, with a 95% confidence interval of 7.0-8.3%. The highest number of cancellations occurred in patients scheduled for major general surgical procedures (n=94, 20%), major urological procedures (n=64, 13%), major orthopaedic surgery (n=38, 8%), and ultra-major cardiothoracic surgery (n=29, 6%). The most common category for cancellation was facility (73%), followed by work-up (17%), patient (10%), and surgeon (1%). No available operating room time due to overrun of the previous surgery was the most common reason for case cancellation (n=310). Compared to general surgery, the odds of no available operating time was significantly less in orthopaedics (odds ratio=0.26; 95% confidence interval, 0.17-0.39), otolaryngology (0.25; 0.13-0.46), neurosurgery (0.36; 0.16-0.70), paediatrics (0.53; 0.31-0.87), gynaecology (0.18; 0.11-0.29), ophthalmology (0.19; 0.07-0.41), and dentistry (0.10; 0.00-0.60). CONCLUSIONS. Case cancellations were mainly due to facility factors, such as no operating room time being available. The odds of having no operating room time available varied between surgical specialties.

[1]  A. Macario.  Are Your Hospital Operating Rooms “Efficient”?: A Scoring System with Eight Performance Indicators , 2006, Anesthesiology.

[2]  Stephen P. Fischer.  Development and Effectiveness of an Anesthesia Preoperative Evaluation Clinic in a Teaching Hospital , 1997 .

[3]  E. Steyerberg,et al.  Predicting the Unpredictable: A New Prediction Model for Operating Room Times Using Individual Characteristics and the Surgeon's Estimate , 2010, Anesthesiology.

[4]  D. Huo,et al.  Preoperative Clinic Visits Reduce Operating Room Cancellations and Delays , 2005, Anesthesiology.

[5]  D. Stubbs,et al.  Measuring the quantitative performance of surgical operating lists: theoretical modelling of ‘productive potential’ and ‘efficiency’ , 2009, Anaesthesia.

[6]  M. Hawn,et al.  Elective surgical case cancellation in the Veterans Health Administration system: identifying areas for improvement. , 2009, American journal of surgery.

[7]  J. Wei,et al.  Improving operating room efficiency through process redesign , 2007 .

[8]  Wilton A. van Klei,et al.  The Effect of Outpatient Preoperative Evaluation of Hospital Inpatients on Cancellation of Surgery and Length of Hospital Stay , 2002, Anesthesia and analgesia.

[9]  Anna Lee,et al.  Perioperative Systems as a quality model of perioperative medicine and surgical care. , 2011, Health policy.

[10]  G. Kazemier,et al.  Improving Operating Room Efficiency by Applying Bin-Packing and Portfolio Techniques to Surgical Case Scheduling , 2007, Anesthesia and analgesia.

[11]  N. Nayab.  Kaizen: The key to Japan‚s competitive success , 2009 .

[12]  A. Bauman,et al.  Risk of unanticipated intraoperative events in patients assessed at a preanaesthetic clinic , 1997, Canadian Journal of Anaesthesia-journal Canadien D Anesthesie.

[13]  T. Butler,et al.  Evaluation of operating room suite efficiency in the Veterans Health Administration system by using data-envelopment analysis. , 2006, American journal of surgery.

[14]  S. Gillett,et al.  Introducing Pay-for-Performance within Hong Kong’s Public Hospitals , 2010, BMC Health Services Research.

[15]  D. Macpherson,et al.  Outpatient Internal Medicine Preoperative Evaluation: A Randomized Clinical Trial , 1994, Medical care.

[16]  F. Chung,et al.  Preadmission anaesthesia consultation clinic , 1992, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[17]  J. Ledolter,et al.  Validation of Statistical Methods to Compare Cancellation Rates on the Day of Surgery , 2005, Anesthesia and analgesia.

[18]  C. Macarthur,et al.  Determinants of pediatric day surgery cancellation. , 1995, Journal of clinical epidemiology.

[19]  J. Pandit,et al.  Estimating the duration of common elective operations: implications for operating list management , 2006, Anaesthesia.

[20]  R. Azarfarin,et al.  Can preoperative anesthesia consultation clinic help to reduce operating room cancellation rate of cardiac surgery on the day of surgery? , 2009, Middle East journal of anaesthesiology.

[21]  T. Voepel-Lewis,et al.  Cancellation of pediatric outpatient surgery: economic and emotional implications for patients and their families. , 1998, Journal of clinical anesthesia.

[22]  Yuchiao Chang,et al.  Increasing Operating Room Efficiency Through Parallel Processing , 2006, Annals of surgery.

[23]  D. Sindhusake,et al.  Cancellation of operations on the day of intended surgery at a major Australian referral hospital , 2005, The Medical journal of Australia.

[24]  M. Carter,et al.  Prediction of the time to complete a series of surgical cases to avoid cardiac operating room overutilization , 2010, Canadian journal of anaesthesia = Journal canadien d'anesthesie.