Let's know why surgical cases are cancelled. Does it happen in your institution?

1. Dr Jay Raj Sharma step2nepal@gmail.com

2. SURGICAL CASE CANCELLING
WHERE CAN WE IMPROVE?
Dr Jay Raj Sharma
Orthopedic Surgeon
Dr Jay Raj Sharma step2nepal@gmail.com

3. Definition
Case cancellation refers to any surgical case
that is booked into the operation theatre list on
the day prior to surgery, but is not operated
upon as scheduled.
An surgical procedure is said to be cancelled
when a patient’s name has appeared on the list
for surgical operations but the operation was
not done on the scheduled date.
Dr Jay Raj Sharma step2nepal@gmail.com

4. Problem
• Cancellation of elective surgery is a significant
problem in many hospitals in that it may lead
to
• dissatisfaction of patients,
• increased costs
• and prolonged patient stay in hospital.
• It also reflects inefficiency in the management
of the operating theatre.
Dr Jay Raj Sharma step2nepal@gmail.com

5. The total number of elective cases booked into the
operative list during the study period was 725, of which
197 (27.2%) was cancelled on the day of surgery.
General surgery had the highest percentage share of total cancellations at 54.8%, followed
by obstetrics gynecology (16.2%), orthopedics (13.1%), ENT (9.1%), urology (3.5%), pediatric
surgery (2%), CTVS and neurosurgery (0.5% each).
There were 9 cases that were cancelled more than once.
They commonest reason for case cancellation was list over
run (73%), followed by lack of patient fitness (14%).
Dr Jay Raj Sharma step2nepal@gmail.com

6. Dr Jay Raj Sharma step2nepal@gmail.com

7. Dr Jay Raj Sharma step2nepal@gmail.com

8. Dr Jay Raj Sharma step2nepal@gmail.com

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12. RECOMMENDATIONS
Dr Jay Raj Sharma step2nepal@gmail.com

13. • A major reduction in the cancellation rate could
be achieved by adopting a few important
interventions, such as creating a bed utilization
manager position in the hospital.
• Anaesthetic protocol defining the parameters
which will render patients as unfit for elective
surgery needs to be communicated to surgical
specialties and consultants in medical and
pediatric departments.
Reasons for cancellation of elective operations at a major teaching referral hospital in
Jordan M. Mesmar,1 N.J. Shatnawi,2 I. Faori 3 and Y.S. Khader 4
Dr Jay Raj Sharma step2nepal@gmail.com

14. RECOMMENDATIONS
• Case cancellation rate can be decreased by earlier
preoperative patient evaluation and listing of only
adequately prepared patients for elective surgery.
• Provision of adequate operating space for the surgical
teams
• and improved communication between surgeons and
the surgical patients can also reduce the rate of
cancellation of elective surgical procedures.
Causes of cancellation of elective surgical operations at a University Teaching Hospital
Ebirim L.N*1, Buowari D.Y1 and Ezike H.A2
Dr Jay Raj Sharma step2nepal@gmail.com

15. ELECTIVE SURGICAL CASE CANCELLATION – AN AUDIT
Nikhil Nanjappa B. A.1, Kirti Katherine Kabeer2, S. Robinson Smile2
1Department of Surgery, M S Ramaiah Medical College, Bangalore, India,
2Department of Surgery, Mahatma Gandhi Medical College & Research Institute,
Pondicherry, India
• The cancellation of surgery creates untold
hardship for patients who plan their working and
family lives around the proposed operation date.
• Most are cancelled at less than 24 hours notice.
• The cost implications to the community are
immense but have not been calculated.
Dr Jay Raj Sharma step2nepal@gmail.com

16. Cancellations due to lack of theatre space and
theatre facilities can be prevented
• through careful planning and efficient
utilization of the already limited hospital
resources including the operating room,
theatre facilities and valuable
manpower.
• Improving the scheduling and admission
procedure is of paramount for better use of
hospital resources.
Dr Jay Raj Sharma step2nepal@gmail.com

17. Dr Jay Raj Sharma step2nepal@gmail.com

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20. Patient related Reasons:
Patient Failed to attend
Patient Request
No “NPO”
Administrative Related reasons:
No bed Available
Overloaded Schedule
Lack of Staff
Lack of equipment
No Blood availableDr Jay Raj Sharma step2nepal@gmail.com

21. Medical related reasons
URTI
High BP
Dr Jay Raj Sharma step2nepal@gmail.com

22. Medical related reasons
URTI
High BP
Unfit because of other medical conditions
Acute illness
Change of treatment Plan
Abnormal Lab reports
Dr Jay Raj Sharma step2nepal@gmail.com

23. Dr Jay Raj Sharma step2nepal@gmail.com