Canceled Total Joint Arthroplasty: Who, What, When, and Why?

Area of Science:

• Orthopedic Surgery
• Health Services Research

Background:

• Scheduled total joint arthroplasty (TJA) cancellations cause significant patient distress and clinical workflow disruption.
• Understanding the reasons for and outcomes of TJA cancellations is crucial for improving patient care and resource management.

Purpose of the Study:

• To identify the primary causes (etiology) of canceled elective total joint arthroplasty (TJA) procedures.
• To determine the subsequent management and outcomes for patients whose TJA surgeries were canceled.

Main Methods:

• A retrospective review of 11,670 patients scheduled for primary hip or knee arthroplasty between 2013 and 2017.
• Identification of canceled procedures and recording of cancellation reasons and time to rescheduling.
• Analysis of patient comorbidities and subsequent medical interventions.

Main Results:

• 4.3% of scheduled TJAs (505 patients) were canceled, with 42% attributed to medical reasons.
• 77% of canceled patients eventually underwent surgery, with an average delay of 165 days.
• Only 25% of patients canceled for medical reasons received further intervention for their condition; these patients had higher comorbidity scores and were more likely to eventually have surgery.

Conclusions:

• Medical concerns are the leading cause of elective TJA cancellations, yet a small proportion of these patients receive subsequent medical intervention.
• Early referral to primary care physicians for medically complex patients may reduce TJA cancellations.
• Establishing clear pathways for rescheduling is essential to minimize delays for patients after a TJA cancellation.