The Effect of Hospital Size and Surgical Service on Case Cancellation in Elective Surgery: Results from a Prospective Multicenter Study

BACKGROUND: Short-term case cancellation causes frustration for anesthesiologists, surgeons, and patients and leads to suboptimal use of operating room (OR) resources. In many facilities, >10% of all cases are cancelled on the day of surgery, thereby causing major problems for OR management and anesthesia departments. The effect of hospital type and service type on case cancellation rate is unclear. METHODS: In 25 hospitals of different types (university hospitals, large community hospitals, and mid- to small-size community hospitals) we studied all elective surgical cases of the following subspecialties over a period of 2 weeks: general surgery, trauma/orthopedics, urology, and gynecology. Case cancellation was defined as any patient who had been scheduled to be operated on the next day, but cancelled after the finalization of the OR plan on the day before surgery. A list of possible cancellation reasons was provided for standardized documentation. RESULTS: A total of 6009 anesthesia cases of 82 different anesthesia services were recorded during the study period. Services in university hospitals had cancellation rates 2.23 (95% confidence interval [CI] = 1.49 to 3.34) times higher than mid- to small-size community hospitals 12.4% (95% CI = 11.0% to 13.8%) versus 5.0% (95% CI = 4.0% to 6.2%). Of the surgical services, general surgical services had a significantly (1.78, 95% CI = 1.25 to 2.53) higher cancellation rate than did gynecology services—11.0% (95% CI = 9.7% to 12.5%) versus 6.6% (95% CI = 5.1% to 8.4%). CONCLUSIONS: When benchmarking cancellation rates among hospitals, comparisons should control for academic institutions having higher incidences of case cancellation than nonacademic hospitals and general surgery services having higher incidences than other services.

[1]  H. Schwartzman,et al.  What Happened at Hawthorne , 1993 .

[2]  J. Evans,et al.  Cancelled elective surgery: an evaluation. , 1994, The American surgeon.

[3]  Marc D Basson,et al.  Predicting Patient Nonappearance for Surgery as a Scheduling Strategy to Optimize Operating Room Utilization in a Veterans' Administration Hospital , 2006, Anesthesiology.

[4]  P. Stepaniak,et al.  The Effect of the Operating Room Coordinator's Risk Appreciation on Operating Room Efficiency , 2009, Anesthesia and analgesia.

[5]  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.

[6]  F. Dexter,et al.  Review of Behavioral Operations Experimental Studies of Newsvendor Problems for Operating Room Management , 2010, Anesthesia and analgesia.

[7]  Warren S. Sandberg,et al.  Causes of Cancellations on the Day of Surgery at Two Major University Hospitals , 2009, Surgical innovation.

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

[9]  F. Dexter,et al.  The Limited Value of Sequencing Cases Based on Their Probability of Cancellation , 2010, Anesthesia and analgesia.

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

[11]  R. Mollan,et al.  Total joint replacement: implication of cancelled operations for hospital costs and waiting list management. , 1992, Quality in health care : QHC.

[12]  M J Tessler,et al.  A "zero tolerance for overtime" increases surgical per case costs. , 1998, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[13]  R. Hand,et al.  The Causes of Cancelled Elective Surgery , 1990, Quality assurance and utilization review : official journal of the American College of Utilization Review Physicians.

[14]  K. Moons,et al.  Implementation of outpatient preoperative evaluation clinics: facilitating and limiting factors. , 2008, British journal of anaesthesia.

[15]  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.

[16]  J. Pollard,et al.  Early outpatient preoperative anesthesia assessment: does it help to reduce operating room cancellations? , 1999, Anesthesia and analgesia.

[17]  E. Søreide,et al.  [Preoperative fasting]. , 1993, Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke.

[18]  A. Woodward,et al.  Cancelled elective operations: an observational study from a district general hospital. , 2007, Journal of health organization and management.

[19]  A. Bader,et al.  Value of Preoperative Clinic Visits in Identifying Issues with Potential Impact on Operating Room Efficiency , 2006, Anesthesiology.

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

[21]  O. Ljungqvist,et al.  Preoperative fasting , 2003, The British journal of surgery.

[22]  J. Ledolter,et al.  Identification of systematic underestimation (bias) of case durations during case scheduling would not markedly reduce overutilized operating room time. , 2007, Journal of clinical anesthesia.

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