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Published in: BMC Surgery 1/2017

Open Access 01-12-2017 | Research article

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

Authors: Kaiye Yu, Xiaolei Xie, Li Luo, Renrong Gong

Published in: BMC Surgery | Issue 1/2017

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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.
Literature
1.
go back to reference Association HFM. Achieving operating room efficiency through process integration. Healthcare Financial Management Journal of the Healthcare Financial Management Association. 2003;57(3) Association HFM. Achieving operating room efficiency through process integration. Healthcare Financial Management Journal of the Healthcare Financial Management Association. 2003;57(3)
2.
go back to reference Azarirad S, Yontef AL, Aleman DM, Urbach DR. Reducing elective general surgery cancellations at a Canadian hospital. Can J Surg. 2013;56(2):113–8.CrossRef Azarirad S, Yontef AL, Aleman DM, Urbach DR. Reducing elective general surgery cancellations at a Canadian hospital. Can J Surg. 2013;56(2):113–8.CrossRef
3.
go back to reference Tait AR, VoepelLewis T, Munro HM, Gutstein HB, Reynolds PI. Cancellation of pediatric outpatient surgery: economic and emotional implications for patients and their families. J Clin Anesth. 1997;9(3):213–9.CrossRefPubMed Tait AR, VoepelLewis T, Munro HM, Gutstein HB, Reynolds PI. Cancellation of pediatric outpatient surgery: economic and emotional implications for patients and their families. J Clin Anesth. 1997;9(3):213–9.CrossRefPubMed
4.
go back to reference Van Klei WA, Moons KGM, Rutten CL, Schuurhuis A, Knape JTA, Kalkman CJ, Grobbee DE. The effect of outpatient preoperative evaluation of hospital inpatients on cancellation of surgery and length of hospital stay. Anesth Analg. 2002;94(3):644–9.CrossRefPubMed Van Klei WA, Moons KGM, Rutten CL, Schuurhuis A, Knape JTA, Kalkman CJ, Grobbee DE. The effect of outpatient preoperative evaluation of hospital inpatients on cancellation of surgery and length of hospital stay. Anesth Analg. 2002;94(3):644–9.CrossRefPubMed
5.
go back to reference Tung A, Dexter F, Jakubczyk S, Glick DB. The limited value of sequencing cases based on their probability of cancellation. Anesth Analg. 2010;111(3):749–56.CrossRefPubMed Tung A, Dexter F, Jakubczyk S, Glick DB. The limited value of sequencing cases based on their probability of cancellation. Anesth Analg. 2010;111(3):749–56.CrossRefPubMed
6.
go back to reference Ivarsson B, Kimblad PO, Sjoberg T, Larsson SH. Patient reactions to cancelled or postponed heart operations. J Nurs Manag. 2002;10(2):75–81.CrossRefPubMed Ivarsson B, Kimblad PO, Sjoberg T, Larsson SH. Patient reactions to cancelled or postponed heart operations. J Nurs Manag. 2002;10(2):75–81.CrossRefPubMed
7.
go back to reference Mangan JL, Walsh C, Kernohan WG, Murphy JS, Mollan RA, McMillen R, Beverland DE. Total joint replacement: implication of cancelled operations for hospital costs and waiting list management. Qual Health Care. 1992;1(1):34–7.CrossRefPubMedPubMedCentral Mangan JL, Walsh C, Kernohan WG, Murphy JS, Mollan RA, McMillen R, Beverland DE. Total joint replacement: implication of cancelled operations for hospital costs and waiting list management. Qual Health Care. 1992;1(1):34–7.CrossRefPubMedPubMedCentral
8.
go back to reference Dexter F, Blake JT, Penning DH, Lubarsky DA. Calculating a potential increase in hospital margin for elective surgery by changing operating room time allocations or increasing nursing staffing to permit completion of more cases: a case study. Anesth Analg. 2002;94(1):138–42.PubMed Dexter F, Blake JT, Penning DH, Lubarsky DA. Calculating a potential increase in hospital margin for elective surgery by changing operating room time allocations or increasing nursing staffing to permit completion of more cases: a case study. Anesth Analg. 2002;94(1):138–42.PubMed
9.
go back to reference Macario A, Dexter F, Traub RD. Hospital profitability per hour of operating room time can vary among surgeons. Anesth Analg. 2001;93(3):669–75.CrossRefPubMed Macario A, Dexter F, Traub RD. Hospital profitability per hour of operating room time can vary among surgeons. Anesth Analg. 2001;93(3):669–75.CrossRefPubMed
10.
go back to reference Chiu CH, Lee A, Chui PT. Cancellation of elective operations on the day of intended surgery in a Hong Kong hospital: point prevalence and reasons. Hong Kong medical journal. 2012;18(1):5–10.PubMed Chiu CH, Lee A, Chui PT. Cancellation of elective operations on the day of intended surgery in a Hong Kong hospital: point prevalence and reasons. Hong Kong medical journal. 2012;18(1):5–10.PubMed
11.
go back to reference Sanjay P, Dodds A, Miller E, Arumugam PJ, Woodward A. Cancelled elective operations: an observational study from a district general hospital. Journal of Health Organisation and Management. 2013;21(1):54–8.CrossRef Sanjay P, Dodds A, Miller E, Arumugam PJ, Woodward A. Cancelled elective operations: an observational study from a district general hospital. Journal of Health Organisation and Management. 2013;21(1):54–8.CrossRef
12.
go back to reference Haana V, Sethuraman K, Stephens L, Rosen H, Meara JG. Case cancellations on the day of surgery: an investigation in an Australian paediatric hospital. ANZ J Surg. 2009;79(9):636–40.CrossRefPubMed Haana V, Sethuraman K, Stephens L, Rosen H, Meara JG. Case cancellations on the day of surgery: an investigation in an Australian paediatric hospital. ANZ J Surg. 2009;79(9):636–40.CrossRefPubMed
13.
go back to reference Seim AR, Fagerhaug T, Ryen SM, Curran P, Saether OD, Myhre HO, Sandberg WS. Causes of cancellations on the day of surgery at two major university hospitals. Surg Innov. 2009;16(2):173–80.CrossRefPubMed Seim AR, Fagerhaug T, Ryen SM, Curran P, Saether OD, Myhre HO, Sandberg WS. Causes of cancellations on the day of surgery at two major university hospitals. Surg Innov. 2009;16(2):173–80.CrossRefPubMed
14.
go back to reference Argo JL, Vick CC, Graham LA, Itani KMF, Bishop MJ, Hawn MT. Elective surgical case cancellation in the veterans health administration system: identifying areas for improvement. Am J Surg. 2009;198(5):600–6.CrossRefPubMed Argo JL, Vick CC, Graham LA, Itani KMF, Bishop MJ, Hawn MT. Elective surgical case cancellation in the veterans health administration system: identifying areas for improvement. Am J Surg. 2009;198(5):600–6.CrossRefPubMed
15.
go back to reference Basson MD, Butler TW, Verma H. Predicting patient nonappearance for surgery as a scheduling strategy to optimize operating room utilization in a veterans' administration hospital. Anesthesiology. 2006;104(4):826–34.CrossRefPubMed Basson MD, Butler TW, Verma H. Predicting patient nonappearance for surgery as a scheduling strategy to optimize operating room utilization in a veterans' administration hospital. Anesthesiology. 2006;104(4):826–34.CrossRefPubMed
16.
go back to reference Ferschl MB, Tung A, Sweitzer B, Huo D, Glick DB. Preoperative clinic visits reduce operating room cancellations and delays. Anesthesiology. 2005;103(4):855.CrossRefPubMed Ferschl MB, Tung A, Sweitzer B, Huo D, Glick DB. Preoperative clinic visits reduce operating room cancellations and delays. Anesthesiology. 2005;103(4):855.CrossRefPubMed
17.
go back to reference Yoon SZ, Lee SI, Lee HW, Lim HJ, Yoon SM, Chang SH. The effect of increasing operating room capacity on day-of-surgery cancellation. Anaesth Intensive Care. 2009;37(2):261.PubMed Yoon SZ, Lee SI, Lee HW, Lim HJ, Yoon SM, Chang SH. The effect of increasing operating room capacity on day-of-surgery cancellation. Anaesth Intensive Care. 2009;37(2):261.PubMed
18.
go back to reference Jokhio AL, Soomro SH, Khuhawer SR, Kandhro MA, Chandio MA. Reasons for cancellation of elective surgical procedures at Chandka medical college hospital, Larkana. Pakistan Rawal Medical Journal. 2014;39(1):61–4. Jokhio AL, Soomro SH, Khuhawer SR, Kandhro MA, Chandio MA. Reasons for cancellation of elective surgical procedures at Chandka medical college hospital, Larkana. Pakistan Rawal Medical Journal. 2014;39(1):61–4.
19.
go back to reference Sung WC, Chou AH, Liao CC, Yang MW, Chang CJ. Operation cancellation at Chang gung memorial hospital. Biom J. 2010;33(05):568–75. Sung WC, Chou AH, Liao CC, Yang MW, Chang CJ. Operation cancellation at Chang gung memorial hospital. Biom J. 2010;33(05):568–75.
20.
go back to reference Schofield WN, Rubin GL, Piza M, Lai YY, Sindhusake D, Fearnside MR, Klineberg PL. Cancellation of operations on the day of intended surgery at a major Australian referral hospital. Med J Aust. 2005;183(10):551. discussion 551 Schofield WN, Rubin GL, Piza M, Lai YY, Sindhusake D, Fearnside MR, Klineberg PL. Cancellation of operations on the day of intended surgery at a major Australian referral hospital. Med J Aust. 2005;183(10):551. discussion 551
21.
go back to reference Caesar U, Karlsson J, Olsson LE, Samuelsson K, Hanssonolofsson E. Incidence and root causes of cancellations for elective orthopaedic procedures: a single center experience of 17,625 consecutive cases. Patient Safety in Surgery. 2014;8(1):24.CrossRefPubMedPubMedCentral Caesar U, Karlsson J, Olsson LE, Samuelsson K, Hanssonolofsson E. Incidence and root causes of cancellations for elective orthopaedic procedures: a single center experience of 17,625 consecutive cases. Patient Safety in Surgery. 2014;8(1):24.CrossRefPubMedPubMedCentral
22.
go back to reference Pohlman GD, Staulcup SJ, Masterson RM, Vemulakonda VM. Contributing factors for cancellations of outpatient pediatric urology procedures: single center experience. J Urol. 2012;188(4):1634–8.CrossRefPubMed Pohlman GD, Staulcup SJ, Masterson RM, Vemulakonda VM. Contributing factors for cancellations of outpatient pediatric urology procedures: single center experience. J Urol. 2012;188(4):1634–8.CrossRefPubMed
23.
go back to reference Dexter F, Marcon E, Epstein RH, Ledolter J. Validation of statistical methods to compare cancellation rates on the day of surgery. Anesth Analg. 2005;101(2):465.CrossRefPubMed Dexter F, Marcon E, Epstein RH, Ledolter J. Validation of statistical methods to compare cancellation rates on the day of surgery. Anesth Analg. 2005;101(2):465.CrossRefPubMed
Metadata
Title
Contributing factors of elective surgical case cancellation: a retrospective cross-sectional study at a single-site hospital
Authors
Kaiye Yu
Xiaolei Xie
Li Luo
Renrong Gong
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2017
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/s12893-017-0296-9

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