Unexpected cancellation of planned elective surgeries is a significant issue that negatively impacts health care quality and results in substantial waste of limited resources [1]. The overall rate of surgery cancellations on the day of surgery varies, ranging from 5% to 40% of planned operations in one survey of hospitals [3]. Surgery cancellations that occur within 24 hours before the scheduled operation have the most financial impact [2]. A 2009 research study at Tulane University Medical Center reported that 6.7% of scheduled elective surgeries were cancelled, amounting to about $1 million in unrealized potential revenue that year [1]. Frequent cancellations of elective surgeries suggests inefficient management and suboptimal patient care [4,6]. However, there are some situations when an anesthesia provider may need to cancel surgery.
Common reasons for an anesthesia provider to cancel surgery include inadequate preoperative assessment, deficiencies in required resources, unavailability of operating rooms, and lack of beds for post-surgery care [2]. Incomplete preoperative evaluation has been identified as the second most common cause of cancellation, trailing behind patient-related factors [2]. According to the American Society of Anesthesiologists (ASA), patients with a history of heart disease, stroke, or heart failure may require additional testing or medication adjustments before surgery to reduce the risk of complications [7]. A complete preoperative assessment often encompasses a detailed history and physical examination, laboratory testing, and possibly chest radiographs and electrocardiographic evaluation [5]. Clinical concerns that often lead to cancellation includes uncontrolled arterial hypertension, recent respiratory infections, uncontrolled diabetes, and acute-onset cardiovascular issues [2]. Since studies from hospitals without established preoperative clinics have reported higher rates of cancellations due to patients being deemed medically unfit, many hospitals have sought to implement such clinics to avoid added stress and cost [2,4]. Surgical centers also implement preoperative evaluations to reduce risk.
Anesthesia providers may also cancel surgery due to noncompliance to preoperative instructions [3]. There are a number of actions that patients must take before undergoing a procedure and receiving anesthesia in order to reduce the risk of complications. Patients who present for surgery without following recommended fasting instructions can face delays and even last-minute cancellations [3]. Another example is patients who come for surgery without stopping their anticoagulation medications, leading to cancellations to avoid increased risk of intraoperative bleeding [3]. The approach to managing patient compliance is to ensure that all preoperative instructions have been communicated in a way that the patient understands [3].
In rare instances, a surgery may need to be canceled in the operating room [4]. A study that evaluated 45,663 surgeries over a 5-year period found that 67 cases (0.15%) were cancelled in the operating room [4]. Although all the patients had preoperative assessments before they arrived in the operating room, 70.2% of the cancelled cases were for medical reasons [4]. Most of the surgeries were cancelled by the attending anesthesia provider before anesthesia was administered due to poor health of the patient, arrhythmia, uncontrolled hypertension, or airway issues [4].
In addition to medical and health-related factors, an anesthesia provider may cancel surgery due to logistical issues. For example, if the surgical team does not have the necessary equipment or supplies to perform the surgery safely, the anesthesia provider may cancel the procedure [2]. Similarly, if the surgical team is understaffed or overbooked, the anesthesia provider may cancel the surgery to ensure that the patient receives proper care [2].
In conclusion, there are several reasons why an anesthesia provider may cancel surgery, including the patient’s medical history, current health status, logistical issues, and patient non-compliance. Anesthesia providers have a responsibility to ensure the safety and well-being of their patients during surgery and may cancel a procedure if they determine that the patient is at increased risk of complications. By working closely with the surgical team and following established protocols and guidelines, anesthesia providers can help ensure that patients receive safe and effective anesthesia care during surgery.
References
- Al Talalwah, N., & McIltrot, K. (2019). Cancellation of surgeries: integrative review. Journal of PeriAnesthesia Nursing, 34(1), 86-96.
- Altun, A., Özer, A., Aksoku, B. et al. (2020). Evaluation of the Reasons for the Cancellation of Elective Procedures at Level 3 University Hospital on the Day of Surgery. Journal of PeriAnesthesia Nursing, 35(5), 514-517.
- Dimitriadis, P., Iyer, S., & Evgeniou, E. (2013). The challenge of cancellations on the day of surgery. International Journal of Surgery, 11(10), 1126-1130.
- Lau, H., Chen, T., Liou, C. et al. (2010). Retrospective analysis of surgery postponed or cancelled in the operating room. Journal of clinical anesthesia, 22(4), 237-240.
- Jimenez, A., Artigas, C., Elia, M. et al. (2006). Cancellations in ambulatory day surgery: Ten years observational study. Ambulatory Surgery, 12(3), 119-123.
- Kumar, R., & Gandhi, R. (2012). Reasons for cancellation of operation on the day of intended surgery in a multidisciplinary 500 bedded hospital. Journal of Anesthesiology, clinical pharmacology, 28(1), 66.
- American Society of Anesthesiologists. (2021). Preparing for Anesthesia. https://www.asahq.org/whensecondscount/preparing-for-anesthesia/
