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Why Do Total Joint Arthroplasties Get Canceled on the Day of Surgery?
Carlos G Sandoval1, Jonathan L Katzman1, Patrick Connolly1
1Department of Orthopedic Surgery, NYU Langone Health, New York, New York.
Background:
Same-day cancellations of elective surgeries present challenges to patients, providers, and health-care institutions. This study aimed to investigate the frequency and predictors of same-day cancellations for elective total joint arthroplasty (TJA).
Methods:
A retrospective review was conducted on 13,744 scheduled primary, elective TJAs at an urban academic center from September 2017 to August 2023. Cases that experienced same-day cancellations were grouped based on the reasoning for cancellation into one of two categories - operative concern (e.g., acute health issues and medication noncompliance) or a nonoperative concern (e.g., financial clearance and transportation issues). Patient demographics were compared between the cancellation and surgery cohorts and between the categorical reasons for cancellation.
Results:
Out of the 38,849 scheduled TJAs, 362 cases (0.9%) were canceled on the day of surgery. Higher patient body mass index was the singular patient factor predictive of same-day cancellation across all TJAs. Non-White race, men, and higher Charlson comorbidity index were additional significant predictors for total hip arthroplasty, but not TKA cancellation. Operative concerns accounted for 74.9% of the cancellations, and nonoperative concerns accounted for 25.1%. Increased patient body mass index was predictive of TJAs canceled due to operative concerns, whereas younger patient age was predictive of TJAs canceled due to nonoperative concerns. Of all same-day cancellations, 81.8% were ultimately rescheduled, and rescheduled cases occurred at a median of 25 days (range, one to 425) after cancellation. There were no significant differences in rescheduling rates and time to reschedule cases between the reasons for cancellation.
Conclusions:
Approximately, 1% of patients experienced a same-day cancellation of their elective TJA, most of which occurred due to operative concerns. These findings may guide the development of preoperative optimization strategies aimed at reducing the occurrence of same-day cancellations for high-risk patients, thereby maximizing the utilization of operative resources and enhancing care for TJA patients.
