Background
Case cancellations pose a significant challenge resulting in a waste of resources, inconvenience to providers and patients, financial strain, and psychosocial consequences to patients. Case cancellations at the day of surgery can be as high as 24% to 40%(1,2). A significant amount of canceled cases are attributed to preventable factors which include incomplete medical/surgical evaluation, lack of insurance authorization, scheduling error, or patient declining surgery(3). In our institution, the contribution margin for each canceled case is estimated to be $6000.
Our study aimed to investigate the amount and type of canceled cases at our institution during an eleven-month period and reasons for cancellations as well as individual patient "risk factors". We characterized associations between variables including patient age, gender, type of surgery, number of comorbidities and preventable and nonpreventable causes of surgery.
Methods
We analyzed all case cancellations in the main operating room in our institution from November 2015 to September 2016, collecting data from the electronic medical record including age, gender, type of surgery, elective versus urgent/emergent surgery and reason for cancellation. We also reviewed patient comorbidity counts and categorized preventable versus nonpreventable surgery. Preventable cancellations included “Surgery already performed”, “Patient rescheduled”, “Patient no show”, “Insurance issues”, “Patient not medically ready”, “patient re-evaluated, surgery not needed”. Nonpreventable cancellations included “Patient no longer wants surgery”, “patient illness/cold”, “patient had surgery elsewhere”, and “patient wants second opinion”. We created a logistic regression model to investigate the impact that variables had on odds that a cancellation was preventable or nonpreventable.
Results
Our patient population consisted of 1819 cancelled cases out of 15910 scheduled cases, for a cancellation rate of 11.43%. The mean age for cancelled cases was 51.92 years old and 52.06% were female versus 47.94% male. 1643 (90.32%) of cancelled cases were "elective", while 11 (0.60%) were "emergent", the remaining falling under the category of "urgent". The most common reason for cancellation was "Patient-No longer wants surgery" with 285 (15.67%), followed by "Provider-Patient not medically ready" with 284 (15.61%). 1006 cancelled cases were considered preventable (62.02%) versus 616 nonpreventable (37.98%). There were 776 cancelled cases the day of or day before surgery (42.66%) versus 731 for greater than one day before scheduled surgery (40.19%).
Based on the logistic regression model every one year increase in age corresponded with a 0.87% decrease in odds that the cancellation was preventable (p=0.002). The odds that cancellation was preventable was 19% higher in males than females (p=0.092), and the odds that an urgent case was preventable was 34.99% higher than that of elective cases (p=0.107).
Conclusion
The majority of cancelled cases at our hospital are elective (90.32%) and/or preventable (62.02%), with the most common preventable reason being “Patient not medically ready”. There was a tendency for a cancellation to be nonpreventable as age increased. Males had a greater tendency to have preventable cancellations than females, as did urgent cases versus elective cases. This study underlines the importance of early intervention to reduce the rate of case cancellations, most of which are preventable.
