Factors Associated with Delayed On-Time Starts and Cancellations of Scheduled Non-Obstetric Surgeries

There is currently lacking research regarding patient and surgical factors contributing to in-hospital delays of gynecologic surgery, and the impact of the COVID-19 pandemic on such cases. The objective of this study was to determine if primary language was associated with delays or cancellations for patients presenting for scheduled non-obstetric surgery. The secondary objectives were to determine if this association changed after the COVID-19 pandemic, and identify other risk factors for delays or cancellations.

This was a retrospective cross-sectional study at a single academic women's hospital. Eligible cases were those undergoing first-case non-obstetric surgeries between January 2019-January 2020 (pre-pandemic), and May 2020-May 2021 (post-pandemic). The primary outcome was delayed start time or same-day cancellation, defined as start time of greater than 10 minutes from scheduled time, or cancellation after arrival. Sample size calculation assumed a 9:1 ratio of English to non-English primary language study population for comparison of first case on-time starts averaging 55% to 75% based on recent hospital data. A sample size of 414 English-speaking and 46 non-English-speaking patients were needed to detect a 20% difference in proportion of on-time start with an alpha of 5% and power of 80%, for a total of 460 charts analyzed from each time point, and 920 charts total. Bivariate analysis and multivariate regression analysis was performed.

In our study population, 90% spoke primarily English. Approximately 74% were non-Hispanic White, 12% Hispanic or Latino, and 6% non-Hispanic Black. Twenty percent of cases were delayed/canceled overall. There was no difference in delays or cancellations by primary language overall, before, or after the COVID-19 pandemic. Factors associated with preoperative delays or cancellations included: non-Hispanic Black race (aOR 2.92, [95% CI 1.56-5.45]), having public or no insurance (aOR 1.45, [95% CI 1.01-2.07]), having diabetes (aOR 2.11 [95% CI 1.23-3.63]), requiring preoperative medications (aOR 1.68 [95% CI 1.08-2.64]), or urogynecologic procedure (aOR 1.89 [95% CI 1.10-2.62]).

Primary language was not associated with first-case delays or cancellations in our study populations. We identified populations at risk for first-case surgical delays. Future qualitative research is needed to identify modifiable causes of delays in perioperative units to guide cost-effective, equitable patient care.