Pattern of cancellation of elective cases

Introduction: Elective surgical procedures are cancelled in different parts of the world for various reasons, ranging from patient factor, surgeon factor and also facility related factors. Irrespective of the reason for cancellation, the effect is debilitating on the affected patients with resultant emotional trauma, waste of time, money and resources, and loss of productivity at work. It also causes a longer waiting list thereby putting pressure on surgeons in the outpatient department. There is inadequate use of resources and loss of revenue to the hospital. Eighty percent of the reasons for cancellations have been found to be avoidable while only 20% are unavoidable. The generally accepted cancellation rate is less than 5%, but there have been rates as high as 49% in some places.
This study was designed to determine the rates of, and reasons for, cancellation of elective cases in our centre and to find out the overall pattern and suggest ways to reduce it.
Materials and Methods- This retrospective study was from April 2019 to March 2023. The data of patients whose cases were cancelled in the study period were extracted from the ‘Cancelled Cases Register’. The data was filled into questionnaires for each patient. In cases of insufficient information in the register, the electronic medical records of the patients were accessed to confirm the details and fill in the missing details.
The data was analyzed using Statistical Package for the Social Sciences (SPSS) Version 27.
Results: We found that a total of 417 elective cases were cancelled, out of 5,729 scheduled cases, with a female: male ratio of 1.1:1. The cancellation rate was 7.3%. Patient-related factors (72.2%) constituted the main reason for cancellation while Facility -related reasons accounted for 15.6% of the cancelled cases. Surgeon -related factors accounted for 12.2% of cancelled cases. Sixty percent of these reasons were avoidable while 40% were not avoidable. General Surgery (31.6%) had the highest number of cancelled cases while Ophthalmology (1%) had the least. Reason for cancellation (patient-related factors, surgeon-related factor and facility-related factors) was significantly associated with elective procedure cancellation (p<0.05). Patient-related factors and Surgeon-related factors are 8 times and 2.42 times respectively more likely to result in cancellation of elective procedures than facility-related factors.
Conclusion: More needs to be done to reduce the rate of cancellation to the barest minimum by addressing the reasons for cancellation. This will reduce patient dissatisfaction, reduce the waiting list and curb wastages in the system.