Abstract
Research Type:
Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies
Introduction/Purpose:
Surgical cancellations have long plagued the US healthcare system in both private and public institutions and orthopaedic surgery has been found to have some of the highest rates of cancellations amongst all specialties. Cancellations within 24 hours of surgery are a major source of wasted resources, financial costs, and patient stress. Finding the root causes of these cancellations can help surgeons and centers lessen the financial and emotional burden of these events. This paper aims to expand the knowledge surrounding surgical cancellations by identifying and describing the most common reasons for cancellations to aid practitioners in preparing patients and operative staff to improve the surgical experience.
Methods:
A retrospective chart review of elective Orthopedic Surgery procedures performed between January 2019 and August 2024 was conducted. All procedures were scheduled to be performed at an outpatient hospital in an urban setting on patients over 18 years of age. Variables collected included date of the procedure, the procedure subspecialty, and the cancellation reason. Reasons for cancellation were divided into four primary categories: patient (i.e. non-adherence to NPO status), medical/anesthesia (i.e. patient not cleared for surgery), surgeon (i.e. surgeon not available for case), and clerical (i.e. case posted incorrectly). Orthopedic subspecialties included in the analysis include trauma, sports, foot and ankle, spine, oncology, joints, and hand. Orthopedic procedures that can be performed by multiple subspecialties, such as ankle fractures (foot and ankle or trauma) and clavicle (sports or trauma), were categorized into the subspecialty of the primary surgeon. Data was aggregated in Excel, and analysis was performed with SAS.
Results:
A total of 27,216 elective orthopedic procedures were performed between January 2019 and August 2024. 1054 procedures were canceled within 24 hours of the scheduled surgery time. The majority of cancelled procedures were to be performed by total joint surgeons (n=448, 43%) followed by hand surgeons (n=173, 16%). The subspecialty with the highest respective cancellation rate was trauma (37.9% of trauma procedures), followed by joints (4.5% of total joints procedures). Detailed information on cancellation reason was available for 197 cases. 98 procedures were cancelled due to patient factors, 38 due to medical/anesthesia factors, 31 due to surgeon factors, and 30 due to clerical factors. The most common patient factors included clearance, lack of transportation, and patient noncompliance with day of surgery instructions (eating, drinking, medications).
Conclusion:
In this study, 1,054 of 27,216 elective orthopedic surgeries (3.9%) were canceled within 24 hours, with total joint procedures accounting for the highest number of cancellations (43%) and trauma surgeries showing the highest relative cancellation rate (37.9%). With these factors identified, this study highlights several opportunities for interventions to reduce same-day cancellations. By focusing on patient engagement, preoperative planning, resource coordination, and administrative efficiency, healthcare institutions can improve operating room function, reduce financial burden, and improve patient outcomes.