Cancelled operations: a 7-day cohort study of planned adult inpatient surgery in 245 UK National Health Service hospitals
Cancelled operations: a 7-day cohort study of planned adult inpatient surgery in 245 UK National Health Service hospitals
Background: cancellation of planned surgery impacts substantially on patients and health systems. This study describes the incidence and reasons for cancellation of inpatient surgery in the UK NHS.
Methods: we conducted a prospective observational cohort study over 7 consecutive days in March 2017 in 245 NHS hospitals. Occurrences and reasons for previous surgical cancellations were recorded. Using multilevel logistic regression, we identified patient- and hospital-level factors associated with cancellation due to inadequate bed capacity.
Results: we analysed data from 14 936 patients undergoing planned surgery. A total of 1499 patients (10.0%) reported previous cancellation for the same procedure; contemporaneous hospital census data indicated that 13.9% patients attending inpatient operations were cancelled on the day of surgery. Non-clinical reasons, predominantly inadequate bed capacity, accounted for a large proportion of previous cancellations. Independent risk factors for cancellation due to inadequate bed capacity included requirement for postoperative critical care [odds ratio (OR)=2.92; 95% confidence interval (CI), 2.12–4.02; P<0.001] and the presence of an emergency department in the treating hospital (OR=4.18; 95% CI, 2.22–7.89; P<0.001). Patients undergoing cancer surgery (OR=0.32; 95% CI, 0.22–0.46; P<0.001), obstetric procedures (OR=0.17; 95% CI, 0.08–0.32; P<0.001), and expedited surgery (OR=0.39; 95% CI, 0.27–0.56; P<0.001) were less likely to be cancelled.
Conclusions: a significant proportion of patients presenting for surgery have experienced a previous cancellation for the same procedure. Cancer surgery is relatively protected, but bed capacity, including postoperative critical care requirements, are significant risk factors for previous cancellations.
Health Services Research, medical resource utilisation, operating room management, surgery
730-738
Wong, D. J.N.
2c41491a-e9fd-474a-96f8-d03778e57669
Harris, S.K.
3d55747d-8115-48ed-8bfe-24440626e947
Moonesinghe, S.R.
2461cb46-56a1-4795-bd9b-0f30e65d6a32
Grocott, Mike
1e87b741-513e-4a22-be13-0f7bb344e8c2
Cumpstey, Andy
cd040417-5e62-41d2-8640-1ec8905858a7
the SNAP-2: EPICCS collaborators
October 2018
Wong, D. J.N.
2c41491a-e9fd-474a-96f8-d03778e57669
Harris, S.K.
3d55747d-8115-48ed-8bfe-24440626e947
Moonesinghe, S.R.
2461cb46-56a1-4795-bd9b-0f30e65d6a32
Grocott, Mike
1e87b741-513e-4a22-be13-0f7bb344e8c2
Cumpstey, Andy
cd040417-5e62-41d2-8640-1ec8905858a7
Wong, D. J.N., Harris, S.K. and Moonesinghe, S.R.
,
the SNAP-2: EPICCS collaborators
(2018)
Cancelled operations: a 7-day cohort study of planned adult inpatient surgery in 245 UK National Health Service hospitals.
British Journal of Anaesthesia, 121 (4), .
(doi:10.1016/j.bja.2018.07.002).
Abstract
Background: cancellation of planned surgery impacts substantially on patients and health systems. This study describes the incidence and reasons for cancellation of inpatient surgery in the UK NHS.
Methods: we conducted a prospective observational cohort study over 7 consecutive days in March 2017 in 245 NHS hospitals. Occurrences and reasons for previous surgical cancellations were recorded. Using multilevel logistic regression, we identified patient- and hospital-level factors associated with cancellation due to inadequate bed capacity.
Results: we analysed data from 14 936 patients undergoing planned surgery. A total of 1499 patients (10.0%) reported previous cancellation for the same procedure; contemporaneous hospital census data indicated that 13.9% patients attending inpatient operations were cancelled on the day of surgery. Non-clinical reasons, predominantly inadequate bed capacity, accounted for a large proportion of previous cancellations. Independent risk factors for cancellation due to inadequate bed capacity included requirement for postoperative critical care [odds ratio (OR)=2.92; 95% confidence interval (CI), 2.12–4.02; P<0.001] and the presence of an emergency department in the treating hospital (OR=4.18; 95% CI, 2.22–7.89; P<0.001). Patients undergoing cancer surgery (OR=0.32; 95% CI, 0.22–0.46; P<0.001), obstetric procedures (OR=0.17; 95% CI, 0.08–0.32; P<0.001), and expedited surgery (OR=0.39; 95% CI, 0.27–0.56; P<0.001) were less likely to be cancelled.
Conclusions: a significant proportion of patients presenting for surgery have experienced a previous cancellation for the same procedure. Cancer surgery is relatively protected, but bed capacity, including postoperative critical care requirements, are significant risk factors for previous cancellations.
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Accepted/In Press date: 9 July 2018
e-pub ahead of print date: 7 September 2018
Published date: October 2018
Keywords:
Health Services Research, medical resource utilisation, operating room management, surgery
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Local EPrints ID: 443486
URI: http://eprints.soton.ac.uk/id/eprint/443486
ISSN: 0007-0912
PURE UUID: 49bd6b33-cff5-447d-bbec-04bb78d09704
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Date deposited: 26 Aug 2020 16:36
Last modified: 13 Dec 2024 03:05
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Contributors
Author:
D. J.N. Wong
Author:
S.K. Harris
Author:
S.R. Moonesinghe
Author:
Andy Cumpstey
Corporate Author: the SNAP-2: EPICCS collaborators
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