Postponement Rate of Elective Surgical Procedures (Postponement)

July 12, 2023 updated by: Rahman Ullah Jan, Hayatabad Medical Complex

Risk Factors Assessment and Postponement Rate of Elective Surgical Procedures in Tertiary Care Public Sector Hospitals, Peshawar, Khyber Pakhtunkhwa, Pakistan-A Multicenter Cross-sectional Study

Postponement of elective surgical procedures is a major issue in health care facilities. It increases burden on hospitals and healthcare systems as well as misery of the patients and their family members. Patient's stay in the hospitals is prolonged. Hospitals and patients resources are wasted and their expenses are increased. The rate of postponement is different in different regions. It is estimated to be in between 9 to 44 %. Reason may be organizational or medical. Elective procedures are cancelled due to insufficient OT timings, non-availability of; anesthetists, blood or beds in ICU, change of plan and medical reasons like respiratory infections, cardiac problems, hypertension and uncontrolled diabetes. Tertiary care hospitals in Peshawar, Khyber Pakhtunkhwa, Pakistan are overburdened and patients on OT list are frequently postponed. Operating room timings has been increased to overcome the issue but no recent data is available regarding actual postponement rate and possible causes in this region. The need is felt to assess the problem and suggest recommendations to decrease patients' sufferings and improve hospital workings.

Study Overview

Status

Completed

Conditions

Detailed Description

Standardized surgical health care and its availability to every person in a community should the objective of a good health system but this is abstruse to complete especially in low and middle income countries. One reason for failure to complete this objective is postponement in elective surgical procedures. It increases burden on hospitals/ healthcare systems as well as misery of the patients and their family members. Patient's stay in the hospitals is prolonged. Hospitals and patients resources are wasted and their expenses are increased. Hospital resources like operation theatre (OT) are underutilized. Surgeons, nursing and other support staff's time is used worthlessly. Patients and attendants face economic and psychological stress. They bear extra financial burden due to stay in hospitals as well as leaves from work. They face more anxiety (42.1 %) and depressive disorders (26.3 %). Patient's health and outcome may deteriorate especially in cardiac, thoracic and cancer patients or in severe category or moribund patients waiting for their surgery.

Pakistan's health care system is based on public and private sector. Public sector health setups provides most facilities free of cost to the community. It is based on primary, secondary and tertiary health care setups. But they are not well integrated and proper referral system to secondary and tertiary health care is weak. Patients are unduly referred to tertiary care hospitals in more than their expected strengths by private clinics as well as by primary and secondary health care setups . Also because of our weak primary and secondary care system, patients coming to tertiary care setups are not aware of their comorbidities like Hypertension, diabetes, ischemic heart diseases, endocrine and respiratory diseases. We also receive fair number of referred patients from our neighboring country; Afghanistan. Some patients admitted for surgical procedures are postponed and are rescheduled for procedures in later dates, thus putting additional burden upon already overburdened system. The rate of postponement is different in different regions. It is estimated to be in between 9 to 44 %. Reason may be organizational or medical. Elective procedures are cancelled due to insufficient OT timings, non-availability of; anesthetists, blood or beds in ICU, change of plan and medical reasons like respiratory infections, cardiac problems, hypertension and uncontrolled diabetes. Cardiac surgeries, cancer surgeries, cholecystectomies, pediatric surgeries and thoracic surgeries are commonly postponed. In an older study done in 2007 in Abbotabad, Khyber Pakhtunkhwa, Pakistan, the postponement rate was 25 %. Elective procedures were cancelled due to shortage of time (36 %), beds (16.2 %), anesthetists (5.8 %) and medical reasons (31%) . Tertiary care hospitals in Peshawar, Khyber Pakhtunkhwa, Pakistan has increased the OR duration from 06 hours to 08 hours and so it is needed to know the new prevalence of cancellation rate of elective procedures and its causes adversely affecting the patients and hospital.

Rationale of the study: Tertiary care hospitals in Peshawar, Khyber Pakhtunkhwa are overburdened and patients on OT list are frequently postponed. Operating room timings has been increased but no recent data is available regarding actual postponement rate and possible causes in this region. The need is felt to assess the problem and suggest recommendations to decrease patients' sufferings and improve hospital workings.

Objectives: To assess the risk factors and postponement rate of elective surgical procedures on the same day of surgery in public sector tertiary care hospitals in Peshawar, Khyber Pakhtunkhwa, Pakistan.

Postponement is defined as cancellation of scheduled elective procedure on the day of operation.

Study Type

Observational

Enrollment (Actual)

1221

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Pakistan
    • KPK
      • Peshawar, KPK, Pakistan, 25000
        • Hayatabad Medical Complex

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

15 years and older (Child, Adult, Older Adult)

Accepts Healthy Volunteers

N/A

Sampling Method

Non-Probability Sample

Study Population

All inpatients admitted in surgical departments of three tertiary care hospitals[ MTI-(HMC, KTH,LRH)], Peshawar, Pakistan and scheduled for elective general surgical procedures.

Description

Inclusion Criteria:

  • All inpatients of any age and either sex admitted in general surgery departments, scheduled for elective surgeries including laparoscopic surgeries, who arrive or are brought to operation theatre for general surgeries as elective cases.

Exclusion Criteria:

  • All outdoor patients.
  • Indoor cases of cardiac, cardiovascular, obstetrics and gynecology, neurosurgery, orthopedics, pediatrics or transplant surgeries or other surgeries considered as specialized surgeries.
  • Emergency surgeries.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Postponement rate of elective surgical procedures
Time Frame: Eight hours

Postponement/ cancellation rate of elective surgical procedures on the same day of surgery will be calculated.

Postponement rate= Total number of elective procedures cancelled / Total number of general surgeries performed in the defined time period * 100
Eight hours

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Risk factors assessment of postponement
Time Frame: Eight hours
Risk factors for postponement of elective surgical procedures on the same day of surgery will be assessed for presence or absence though a questionnaire.
Eight hours

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Hayatabad Medical Complex

Investigators

  • Principal Investigator: Rahman U Jan, Hayatabad Medical Complex

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

May 19, 2022

Primary Completion (Actual)

August 19, 2022

Study Completion (Actual)

February 15, 2023

Study Registration Dates

First Submitted

April 25, 2022

First Submitted That Met QC Criteria

April 25, 2022

First Posted (Actual)

April 29, 2022

Study Record Updates

Last Update Posted (Actual)

July 14, 2023

Last Update Submitted That Met QC Criteria

July 12, 2023

Last Verified

July 1, 2023

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • 616/HEC/B&PSC/2022

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

Data including clinical and demographic characteristics, not affecting patient's confidentiality, will be shared.

IPD Sharing Time Frame

December, 2022 to December, 2025

IPD Sharing Access Criteria

IPD will be shared on inter institutional request basis.

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • SAP
  • ICF
  • ANALYTIC_CODE
  • CSR

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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