DESCRIPTIVE STUDY OF ELECTIVE SURGICAL CASE CANCELLATION RATES AND ASSOCIATED PATIENT-LEVEL FACTORS
Main Article Content
Keywords
Elective surgical cancellation; operating theatre efficiency; preoperative assessment; ASA physical status; MMIMSR Mullana; Haryana; perioperative care; descriptive study
Abstract
Elective surgical case cancellation is a significant operational and clinical problem confronting tertiary-care teaching hospitals across India. Cancellations disrupt operating theatre scheduling, impair hospital resource utilisation, cause patient distress, and generate avoidable healthcare costs. Maharishi Markandeshwar Institute of Medical Sciences and Research (MMIMSR), Mullana, Ambala, is a major teaching hospital serving a predominantly agrarian population from Ambala, Kurukshetra, Panchkula, and adjacent districts of Haryana. Despite the clinical and administrative significance of cancellation rates, no institution-specific data existed at MMIMSR prior to this study. This descriptive study was conducted to quantify the burden, characterise the causes, and identify patient-level risk factors for elective surgical case cancellation at MMIMSR.
Objectives
To determine the overall elective surgical cancellation rate at MMIMSR, Mullana, over a defined six-month study period; to describe the spectrum and frequency of causes; and to identify patient-level demographic and clinical factors independently associated with cancellation.
Methodology
A hospital-based descriptive study with retrospective record review was conducted from March 2019 to August 2019. All elective surgical cases scheduled in the main operating theatre complex at MMIMSR (N=1,248) were included. Cancellation was defined as failure to perform a scheduled elective surgical procedure on the planned date. Data were extracted from anaesthesia records, surgical schedules, and patient case files using a validated proforma. Descriptive statistics, chi-square tests, and binary logistic regression were performed using SPSS v21.0 and Microsoft Excel 2016.
Results
Of 1,248 scheduled elective cases, 214 were cancelled (overall cancellation rate 17.1%; 95% CI: 15.0–19.3%). Patient-related causes accounted for 72.9% (n=156) of cancellations, led by inadequate preoperative workup (24.3%) and patient non-reporting (19.6%). System-related causes contributed 27.1% (n=58). The cancellation rate was highest in July (21.1%) and lowest in April (14.1%). On multivariate logistic regression, independent predictors of cancellation were ASA grade III–IV (adjusted OR 4.68; p < 0.001), inadequate preoperative workup (adjusted OR 38.40; p < 0.001), chronic kidney disease (adjusted OR 3.12; p < 0.001), ischaemic heart disease (adjusted OR 2.84; p < 0.001), age > 60 years (adjusted OR 1.84; p < 0.001), and anaemia Hb < 10 g/dL (adjusted OR 2.68; p < 0.001).
Conclusion
The elective surgical cancellation rate of 17.1% at MMIMSR substantially exceeds the internationally accepted benchmark of < 5% and reflects both preventable patient-level and system-level deficiencies. A structured preoperative assessment clinic with mandatory anaesthesia review, standardised investigation protocols, and a patient communication system should be established at MMIMSR to reduce avoidable cancellations and optimise theatre utilisation.
References
2. Ferschl MB, Tung A, Sweitzer BJ, Huo D, Glick DB. Preoperative clinic visits reduce operating room cancellations and delays. Anesthesiology. 2005;103(4):855–9.
3. Trentman TL, Mueller JT, Fassett SL, Stevens SR, Renfree KJ. Day of surgery cancellations in a tertiary care hospital. J Anaesthesiol Clin Pharmacol. 2010;26(1):68–71.
4. Makama JG, Ameh EA. Cancelled elective surgical operations at Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Niger J Med. 2009;18(3):290–3.
5. Garg R. Cancellation of elective operation on the day of intended surgery in a multidisciplinary 500 bedded hospital: prospective audit. Indian J Anaesth. 2009;53(2):178–83.
6. Mathur S. Audit of elective case cancellations at a tertiary care hospital in India. J Anaesthesiol Clin Pharmacol. 2017;33(2):249–54.
7. Dimitriadis PA, Iyer S, Evgeniou E. The challenge of cancellations on the day of surgery. Int J Surg. 2013;11(10):1126–30.
8. Hovlid E, Bukve O, Haug K, Aslaksen AB, von Plessen C. Sustainability of healthcare improvement: what can we learn from learning theory? BMC Health Serv Res. 2012;12(1):235.
9. Kumar R, Gandhi R. Reasons for cancellation of operation on the day of intended surgery in a multidisciplinary 500 bedded hospital. J Anaesthesiol Clin Pharmacol. 2012;28(1):66–9.
10. Schofield WN, Rubin GL, Piza M, Ng YL, Barratt A, Freeman CR, et al. Cancellation of operations on the day of intended surgery at a major Australian referral hospital. Med J Aust. 2005;182(12):612–5.
11. Vinukondaiah K, Ananthakrishnan N, Ravishankar M. Audit of operation theatre utilization in general surgery. Natl Med J India. 2000;13(3):118–21.
12. Kaur R, Dahiya D, Sood S, Agnihotri G. Audit of cancellations in elective surgery list at a North Indian teaching hospital. Int J Res Med Sci. 2017;5(1):241–5.
13. Kshirsagar S, Lele SS, Chhabriya A. Analysis of cancellation of elective surgeries at a teaching hospital. Indian J Surg. 2018;80(5):477–81.
14. Ramkumar V, Umesh G, Tony PA. Preoperative anxiety in children: a comparison of intranasal dexmedetomidine versus oral midazolam. J Anaesthesiol Clin Pharmacol. 2018;34(3):403–7.
15. Bhatt M, Makwana I, Patel K. Economic analysis of surgical case cancellations at a teaching hospital: implications for policy. Indian J Anaesth. 2016;60(4):270–4.
16. IBM Corp. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp; 2012.
17. World Medical Association. Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–4.
18. Indian Council of Medical Research. National Ethical Guidelines for Biomedical and Health Research Involving Human Participants. New Delhi: ICMR; 2017.
19. Panda N, Bhagat R, Balakrishnan S. Causes of cancellation of elective surgical cases at a teaching hospital. J Clin Diagn Res. 2015;9(9):UC01–3.
20. Lacqua MJ, Evans JT. Cancelled elective surgery: an evaluation. Am Surg. 1994;60(11):809–11.
21. Haana V, Maiese EM, Osip J, Aoun P, Nason KS. Evaluating day-of-surgery cancellations at a large university hospital. Surg Endosc. 2016;30(12):5519–26.
22. Argo JL, Vick CC, Graham LA, Itani KM, 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.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Viral Sshaill Shah
Associate Professor, Department of Anaesthesiology, M M Institute of Medical Sciences & Research, Mullana, Ambala, Haryana, India
Dr. Arunkumar R Varun
Associate Professor, Department of Community Medicine, Career Institute of Medical Sciences & Hospital, I.I.M. Road, Ghailla, Lucknow, UP, India
