Causes of Elective Surgery Procedure Cancellation in a Portuguese General Hospital: A Cross-Sectional Observational Study

Elective surgery cancellation is a source of patient dissatisfaction and improper resource allocation, since it decreases the working efficiency of the operating theater and increases healthcare system costs. Knowing the causes behind cancellation can be helpful in establishing an action plan to prevent them from happening. This study aimed to quantify the rate and identify the main causes of elective surgery cancellation at a Portuguese general hospital, and to examine the relationship between cancellation causes and relevant clinical and organizational variables.

Data regarding elective surgery cancellations from January to October 2023 were collected retrospectively. Details on the type of surgery, American Society of Anesthesiologists (ASA) physical status, pre-anesthetic assessment, and the specific reason for cancellation were gathered.

During the period analyzed, 5284 elective surgeries were scheduled. The local cancellation rate was 12.24%. Most of the postponed patients attended the preoperative anesthetic evaluation (82.8%, n = 536). The five main causes identified were "strike," "lack of theater time," "patient-related factors-disease," "patient did not attend," and "patient-related factors-other reasons." The most frequent cause of cancellation was strike (54%, n = 350), followed by lack of theater time (23.3%, n = 152) and patient-related factors-disease (9.7%, n = 63). By specialty, most cases were cancelled in orthopedics (25.8%, n = 167), followed by general surgery (21.2%, n = 137).

Cancellations have an adverse effect on the concept of theater "efficiency." After the "strike," we found that "lack of theater time" was the most important modifiable cause for elective surgical cancellation. To define the processes that can be improved, an audit could be done, in the future, to assess problems of scheduling, overbooking, or theater over-utilization. Future directions could also include a more profound analysis of the impact of multidisciplinary preoperative anesthesia clinic evaluation on cancellation rates.