The Cost of Last-Minute Cancellation: Analysis of Timing, Reason, and the Block Time You Won't Get Back

The aim of this study was to determine if cancellations within 1 week of surgery are more costly and whether failure to obtain medical clearance is a common reason for nonelective cancellation.

A retrospective review of 1,684 consecutive scheduled surgeries at 1 surgery center by 1 surgeon was performed. Demographics, including age, gender, and hand dominance; timing of surgical scheduling; and surgery type were recorded. Cancellations within 2 weeks of surgery were recorded including the date and reason, categorized as elective and nonelective, and whether the timeslot was filled or unfilled. Cancellations were analyzed based on number of days prior to surgery: 0 to 7 versus 8 to 14 days versus >14 days from surgery. Estimated revenue and Relative Value Unit (RVU) losses were calculated using values and the average revenue of shoulder surgery found in existing literature. Statistical analysis was used for comparisons between the groups using t-tests, analysis of variance, χ² test, and Fisher exact test.

There were 175 cancellations, 96 occurring within 2 weeks of the scheduled surgery. The average cancellation time was 5.9 ± 4.2 days before surgery. 43.8% (28/64) of cancellations 0 to 7 days before surgery were filled, a significantly lower number compared with those that occurred 8 to 14 days earlier with 93.4% (30/32) of timeslots filled following the cancellation (p = 0.00), and all cancelations >14 days before surgery were filled (79/79). The rate of elective and nonelective cancellations did not differ between the 0 to 7 and 8 to 14 days (p = 0.74). Nonelective cancellations related to lack of medical clearance contributed to 17.2% (11/64) of cancellations that occurred 0 to 7 days before surgery. Approximately $385,624 or 2,990 RVUs of revenue was lost due to unfilled timeslots.

There was an inflection point observed 7 days before scheduled surgery, which marked a statistically significant decrease in the rate at which surgical cancellations were filled with alternative cases at available surgical timeslots. Lack of medical clearance also led to a substantial loss of revenue.

Level III. See Instructions for Authors for a complete description of levels of evidence.