Risk Factors and Reasons for Cancellation Within 24 Hours of Scheduled Elective Surgery in an Academic Medical Centre

The Operating Theatre (OT) is the largest cost centre as well as the main revenue generator in most hospitals. The operating theatre involves significant resources - materials, medications and manpower. One of the common problems affecting optimal OT utilization is the cancellation of scheduled surgeries. This results in a significant waste of resources, especially when cancellation occurs within 24 hours of the scheduled surgery, when it is too late to arrange replacement surgery. Cancellation also impacts the patient and their families.

Reported cancellation rates range between 5% to 40%. Reasons for cancellations vary, including patient factors, surgeon factors, and system issues relating to the preoperative anaesthesia assessment clinic attendance, the surgery itself, and the availability of post-surgical care facilities. Between 60% to 90% of cancellations have been reported to be potentially avoidable.

The goal of this study was to identify factors associated with cancellation within 24 hours of scheduled surgery in a tertiary academic hospital, and the reasons for cancellation, with the goal of identifying areas for intervention to reduce avoidable surgery cancellations and reduce unnecessary waste.

Adult patients (age 18 years and older) who were scheduled for elective surgery at the Singapore General Hospital main operating theatre or ambulatory surgical centre, regardless of surgical discipline, or residency, were included in the study. Only the first surgery in the study period was included if a patient had multiple surgeries over this period. Minor surgeries under local anaesthesia were also excluded. We excluded those without previous admissions in the past 3 years prior to the surgery, as data for chronic disease history and healthcare utilization patterns were not available for these patients