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.
| Original language | English |
|---|---|
| Pages (from-to) | 730-738 |
| Number of pages | 9 |
| Journal | British Journal of Anaesthesia |
| Volume | 121 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - 1 Oct 2018 |
Bibliographical note
Publisher Copyright:© 2018 British Journal of Anaesthesia
Keywords
- Health Services Research
- medical resource utilisation
- operating room management
- surgery
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In: British Journal of Anaesthesia, Vol. 121, No. 4, 01.10.2018, p. 730-738.
Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - Cancelled operations
T2 - a 7-day cohort study of planned adult inpatient surgery in 245 UK National Health Service hospitals
AU - Weston Area Health NHS Trust
AU - West Suffolk NHS Foundation Trust
AU - The Whittington Hospital NHS Trust
AU - Wirral University Teaching Hospital NHS Foundation Trust
AU - Worcestershire Acute Hospitals NHS Trust
AU - Wrightington, Wigan and Leigh NHS Foundation Trust
AU - Wye Valley NHS Trust
AU - Yeovil District Hospital NHS Foundation Trust
AU - York Teaching Hospital NHS Foundation Trust
AU - the SNAP-2: EPICCS collaborators
AU - Health Services Research Centre, National Institute of Academic Anaesthesia
AU - Study Steering Group
AU - Net Solving Limited
AU - Trainee Research Networks
AU - Abertawe Bro Morgannwg University Health Board
AU - Aintree University Hospitals NHS Foundation Trust
AU - Airedale NHS Foundation Trust
AU - Aneurin Bevan Health Board
AU - Ashford & St Peters NHS Foundation Trust
AU - Barking, Havering and Redbridge University Hospitals NHS Trust
AU - Barnsley Hospital NHS Foundation Trust
AU - Barts Health NHS Trust
AU - Basildon and Thurrock University Hospitals NHS Foundation Trust
AU - Bedford Hospital NHS Trust
AU - Belfast Health and Social Care Trust
AU - Betsi Cadwaladr University Health Board
AU - Birmingham Women's NHS Foundation Trust
AU - Blackpool Teaching Hospitals NHS Foundation Trust
AU - Bolton Hospital NHS Foundation Trust
AU - Bradford Teaching Hospitals NHS Foundation Trust
AU - Brighton and Sussex University Hospitals NHS Trust
AU - Buckinghamshire Healthcare NHS Trust
AU - Burton Hospitals NHS Foundation Trust
AU - Calderdale and Huddersfield NHS Foundation Trust
AU - Cambridge University Hospitals NHS Foundation Trust
AU - Cardiff and Vale University Health Board
AU - Central Manchester University Hospitals NHS Foundation Trust
AU - Chelsea and Westminster Hospital NHS Foundation Trust
AU - Chesterfield Royal Hospital NHS Foundation Trust
AU - The Christie Hospital NHS Foundation Trust
AU - City Hospitals Sunderland NHS Foundation Trust
AU - Colchester Hospital University NHS Foundation Trust
AU - Countess of Chester NHS Foundation Trust
AU - County Durham and Darlington NHS Foundation Trust
AU - Croydon Health Services NHS Trust
AU - Cwm Taf University Health Board
AU - Dartford and Gravesham NHS Trust
AU - Derby Hospitals NHS Foundation Trust
AU - Doncaster and Bassetlaw Hospitals NHS Foundation Trust
AU - Dorset County Hospital NHS Foundation Trust
AU - The Dudley Group NHS Foundation Trust
AU - East and North Hertfordshire NHS Trust
AU - East Kent Hospitals University NHS Foundation Trust
AU - East Lancashire Hospitals NHS Trust
AU - East Sussex Healthcare NHS Trust
AU - Epsom and St Helier University Hospitals NHS Trust
AU - Frimley Health NHS Foundation Trust
AU - Gateshead Health NHS Foundation Trust
AU - Gloucestershire Hospitals NHS Foundation Trust
AU - Great Western Hospitals NHS Foundation Trust
AU - Guy's and St Thomas’ NHS Foundation Trust
AU - Hampshire Hospitals NHS Foundation Trust
AU - Harrogate and District NHS Foundation Trust
AU - Heart Of England NHS Foundation Trust
AU - The Hillingdon Hospitals NHS Foundation Trust
AU - Homerton University Hospital NHS Foundation Trust
AU - Hull and East Yorkshire Hospitals NHS Trust
AU - Hywel Dda Health Board
AU - Imperial College Healthcare NHS Trust
AU - Ipswich Hospital NHS Trust
AU - Isle of Wight NHS Trust
AU - James Paget University Hospitals NHS Foundation Trust
AU - Kettering General Hospital NHS Foundation Trust
AU - King's College Hospital NHS Foundation Trust
AU - Kingston Hospital NHS Foundation Trust
AU - Lancashire Teaching Hospitals NHS Foundation Trust
AU - Leeds Teaching Hospitals NHS Trust
AU - Lewisham and Greenwich NHS Trust
AU - Liverpool Women's NHS Foundation Trust
AU - Luton and Dunstable University Hospital NHS Foundation Trust
AU - Medway NHS Foundation Trust
AU - Mid Cheshire Hospitals NHS Foundation Trust
AU - Mid Essex Hospital Services NHS Trust
AU - Mid Yorkshire Hospitals NHS Trust
AU - Milton Keynes University Hospital NHS Foundation Trust
AU - Newcastle upon Tyne Hospitals NHS Foundation Trust
AU - NHS Ayrshire & Arran
AU - NHS Dumfries & Galloway
AU - NHS Fife
AU - NHS Greater Glasgow & Clyde
AU - NHS Highland
AU - NHS Lanarkshire
AU - NHS Lothian
AU - NHS Scotland Special Board
AU - NHS Shetland
AU - NHS Tayside
AU - Norfolk and Norwich University Hospitals NHS Foundation Trust
AU - Northampton General Hospital NHS Trust
AU - North Bristol NHS Trust
AU - North Cumbria University Hospitals NHS Trust
AU - Northern Devon Healthcare NHS Trust
AU - Northern Health and Social Care Trust
AU - Northern Lincolnshire and Goole Hospitals NHS Foundation Trust
AU - North Middlesex University Hospital NHS Trust
AU - North Tees and Hartlepool NHS Trust
AU - Northumbria Healthcare NHS Foundation Trust
AU - North West Anglia NHS Foundation Trust
AU - Nottingham University Hospitals NHS Trust
AU - Oxford University Hospitals NHS Foundation Trust
AU - Papworth Hospital NHS Foundation Trust
AU - Pennine Acute NHS Trust
AU - Plymouth Hospitals NHS Trust
AU - Poole Hospital NHS Foundation Trust
AU - Portsmouth Hospitals NHS Trust
AU - The Princess Alexandra Hospital NHS Trust
AU - Queen Elizabeth Hospital NHS Foundation Trust
AU - Queen Victoria Hospital NHS Foundation Trust
AU - Robert Jones and Agnes Hunt Orthopaedic Hospital Foundation Trust
AU - Rotherham NHS Foundation Trust
AU - Royal Berkshire NHS Foundation Trust
AU - Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust
AU - Royal Cornwall Hospitals NHS Trust
AU - Royal Devon and Exeter NHS Foundation Trust
AU - Royal Free London NHS Foundation Trust
AU - The Royal Liverpool and Broadgreen University Hospitals NHS Trust
AU - The Royal Marsden NHS Foundation Trust
AU - Royal National Orthopaedic Hospital NHS Trust
AU - The Royal Orthopaedic Hospital NHS Foundation Trust
AU - Royal Surrey County Hospital NHS Foundation Trust
AU - Royal United Hospitals Bath NHS Trust
AU - The Royal Wolverhampton Hospitals NHS Trust
AU - Salford Royal NHS Foundation Trust
AU - Salisbury NHS Foundation Trust
AU - Sandwell and West Birmingham Hospitals NHS Trust
AU - Sheffield Teaching Hospitals NHS Foundation Trust
AU - Shrewsbury and Telford Hospital NHS Trust
AU - South Eastern Health and Social Care Trust
AU - Southport and Ormskirk Hospital NHS Trust
AU - South Tees Hospitals NHS Foundation Trust
AU - South Tyneside NHS Foundation Trust
AU - South Warwickshire NHS Foundation Trust
AU - St George's Healthcare NHS Trust
AU - St Helens and Knowsley Teaching Hospitals NHS Trust
AU - Stockport NHS Foundation Trust
AU - Surrey and Sussex Healthcare NHS Trust
AU - Tameside Hospital NHS Foundation Trust
AU - Taunton and Somerset NHS Foundation Trust
AU - Torbay and South Devon NHS Foundation Trust
AU - United Lincolnshire Hospitals NHS Trust
AU - University College London Hospitals NHS Foundation Trust
AU - University Hospital of North Midlands NHS Trust
AU - University Hospital of South Manchester NHS Foundation Trust
AU - University Hospitals Birmingham NHS Foundation Trust
AU - University Hospitals Bristol NHS Foundation Trust
AU - University Hospitals Coventry and Warwickshire NHS Trust
AU - University Hospitals of Leicester NHS Trust
AU - University Hospitals of Morecambe Bay NHS Foundation Trust
AU - University Hospital Southampton NHS Foundation Trust
AU - Walsall Healthcare NHS Trust
AU - Warrington & Halton Hospitals NHS Foundation Trust
AU - Western Health and Social Care Trust
AU - Western Sussex Hospitals NHS Foundation Trust
AU - West Herts Hospitals NHS Trust
AU - Wong, Danny J.N.
AU - Harris, S. K.
AU - Moonesinghe, S. R.
AU - Harris, Steve K.
AU - Bedford, James
AU - Boney, Oliver
AU - Chazapis, Maria
AU - Drake, Sharon
AU - Farmer, Laura
AU - Gilhooly, David
AU - Goodwin, James
AU - Lourtie, Jose
AU - Wagstaff, Duncan
AU - Grocott, Mike
AU - Sneyd, Robert
AU - Batchelor, Anna
AU - Brett, Stephen
AU - Plowright, Catherine
AU - Shrestha, Suman
AU - Shawyer, Richard
AU - Ahmed, Shafi
AU - Khondoker, Mizan
AU - Nathanson, Mike
AU - Cripps, Paul
AU - Research & Audit Federation of Trainees (RAFT), & Audit Federation of Trainees (RAFT)
AU - Anaesthetic Audit, Audit
AU - Intensive Care & Anaesthesia Research Network of North East Trainees (INCARNNET), Care & Anaesthesia Research Network of North East Trainees (INCARNNET)
AU - Merseyside Anaesthetic Group for Improving Quality (MAGIQ), Anaesthetic Group for Improving Quality (MAGIQ)
AU - Midlands East Research by Critical Care, East Research by Critical Care
AU - North West Research, West Research
AU - Oxford Critical Care Anaesthetic Research Enterprise (OxCCARE), Critical Care Anaesthetic Research Enterprise (OxCCARE)
AU - Pan-London Peri-operative Audit & Research Network (PLAN), Peri-operative Audit & Research Network (PLAN)
AU - Scottish East Quality Improvement & Research Academy (SEQuoIA), East Quality Improvement & Research Academy (SEQuoIA)
AU - SESSA Quality Improvement, Quality Improvement
AU - Severn Trainees Anaesthetic Research (STAR), Trainees Anaesthetic Research (STAR)
AU - South West Anaesthetic Research Matrix (SWARM), West Anaesthetic Research Matrix (SWARM)
AU - South Yorkshire Hospitals Audit, Yorkshire Hospitals Audit
AU - Southcoast Peri-operative Audit, Peri-operative Audit
AU - Welsh Anaesthetic Audit Research & Engagement Network (WAAREN), Anaesthetic Audit Research & Engagement Network (WAAREN)
AU - West Midlands Trainee Research Anaesthesia & Intensive Care Network (WMTRAIN), Midlands Trainee Research Anaesthesia & Intensive Care Network (WMTRAIN)
AU - Rawat, Shilpa
AU - Sathe, Sonia
AU - Campbell, Alison
AU - Anandarajah, Janakan
AU - Ball, Nicola
AU - Bandara, Lalindra
AU - Barnes, Dennis
AU - Chapman, Catherine
AU - Connor, Lynda
AU - Williams, Sarah
N1 - Publisher Copyright: © 2018 British Journal of Anaesthesia
PY - 2018/10/1
Y1 - 2018/10/1
N2 - 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.
AB - 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.
KW - Health Services Research
KW - medical resource utilisation
KW - operating room management
KW - surgery
UR - http://www.scopus.com/inward/record.url?scp=85054450371&partnerID=8YFLogxK
U2 - 10.1016/j.bja.2018.07.002
DO - 10.1016/j.bja.2018.07.002
M3 - Article
C2 - 30236235
AN - SCOPUS:85054450371
SN - 0007-0912
VL - 121
SP - 730
EP - 738
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 4
ER -