Cancellation of elective cases in pediatric surgery: An audit

Sapna Bathla, Anup Mohta, Aikta Gupta, Geeta Kamal, Sapna Bathla, Anup Mohta, Aikta Gupta, Geeta Kamal

Abstract

Aim: To determine the main reasons for cancellation of elective cases on scheduled date of surgery in pediatric patients.

Materials and methods: The audit was conducted in a 216 beds tertiary care pediatric super-specialty hospital. Two operation theatres (OT) provide elective surgical services to pediatric surgery, orthopedics, ophthalmology and otorhinolaryngology. The audit included all those patients who were posted for elective surgery over a period of one year. Cancelled cases were identified from predesigned OT utilization formats and the reasons for cancellation were evaluated.

Results: A total of 2473 cases were posted for the elective surgery in the year 2009 and 189 (7.64%) patients had their surgery cancelled. The main reasons for cancellation were upper respiratory infections (30.68%) and shortage of time (29%). Other reasons were medically unfit patients (15.34%), precedence of emergency cases (3.7%); non-availability of ventilator and intensive care bed (4.7%); no-show by patient (4.76%); non-availability of blood (4.2%); incomplete work up (2.64%); administrative reasons (1.58%); patient not fasting (1.58%) and unspecified reasons (2.1%). Overall, 38.6% causes were preventable.

Conclusions: Elective surgery cancellation is a significant problem with multifactorial etiology. Most common reasons for cancellation of planned surgery were sudden onset of respiratory tract infection in the admitted patient and shortage of time. It suggests that on many occasions, surgeons take more time than anticipated for performing the procedure.

Keywords: Elective surgery; operating room; pediatric.

Conflict of interest statement

Conflict of Interest: None declared.

References

    1. Boothe P, Finegan BA. Changing the admission process for elective surgery: An economic analysis. Can J Anaesth. 1995;42:391–4.
    1. Rai MR, Pandit JJ. Day of surgery cancellations after nurse led pre-assessment in an elective surgery centre: The first 2 years. Anaesthesia. 2003;8:692–9.
    1. Tait AR, Voepel-Lewis T, Munro HM, Gutstein HB, Reynolds PI. Cancellation of paediatric out-patient surgery: Economic and emotional implications for patients and their families. J Clin Anesth. 1997;9:213–9.
    1. Sevgi D, Fatma E. The causes and consequences of cancellations in planned orthopedic surgery: The reactions of the patients and their families. J Ortho Nurs. 2004;8:11–9.
    1. Garg R, Bhalotra AR, Bhadoria P, Gupta N, Anand R. Reasons for cancellation of cases on the day of surgery –A Prospective Study. Indian J Anaesth. 2009;53:35–9.
    1. Haana V, Sethuraman K, Stephens L, Rosen H, Meara JG. Case cancellations on the day of surgery: An investigation in an Australian paediatric hospital. ANZ J Surg. 2009;79:636–40.
    1. Tait AR, Malviya S. Anaesthesia for the child with an upper respiratory tract infection: Still a dilemma? Anesth Analg. 2005;100:59–65.
    1. Cohen MM, Cameron CB. Should you cancel the operation which a child has an upper respiratory tract infection? Anesth Analg. 1991;72:282–8.
    1. Parnis SJ, Barker DS, Van Der Walt JH. Clinical predictors of anaesthetic complications in children with respiratory tract infections. Paediatr Anaesth. 2001;11:29–40.
    1. Tait AR, Malviya S, Voepel-Lewis T, Munro HM, Seiwert M, Pandit UA. Risk factors for perioperative adverse respiratory events in children with upper respiratory tract infections. Anesthesiology. 2001;95:299–306.
    1. Empey DW, Laitinen LA, Jacobs L, Gold WL, Nadle JA. Mechanisms of bronchial hyperreactivity in normal subjects after upper respiratory tract infection. Am Rev Respir Dis. 1976;113:131–9.
    1. Aquilina AT, Hall WJ, Douglas RG, Jr, Utell MJ. Airway reactivity in subjects with viral upper respiratory tract infections: The effects of exercise and cold air. Am Rev Respir Dis. 1980;122:3–10.
    1. Tait AR, Reynolds PI, Gutstein HB. Factors that influence an anesthesiologists decision to cancel elective surgery for the child with an upper respiratory tract infection. J Clin Anesth. 1995;7:491–9.
    1. Berry FA. Preexisting medical conditions of pediatric patients. Semin Anesth. 1984;3:24–31.
    1. Tait AR, Knight PR. The effects of general anaesthesia on upper respiratory tract infections in children. Anaesthesiology. 1987;67:930–5.
    1. Elwood T, Morris W, Martin L, Nespeca MK, Wilson DA, Fleisher EA, et al. Bronchodilator premedication does not decrease respiratory adverse events in pediatric general anesthesia. Can J Anaesth. 2003;50:277–84.
    1. Cote CJ. The upper respiratory tract infection dilemma: Fear of complication or litigation? Anaesthesiology. 2001;95:283–5.
    1. Schofield WN, Rubin GL, Piza M, Lai YY, Sindhusake D, Fearnside MR, et al. Cancellation of operations on day of intended surgery at a Major Australian referral hospital. Med J Aust. 2005;182:612–5.
    1. Down MP, Wong DT, McGuire GP. The anaesthesia consult clinic: Does it matter which anaesthetist sees the patient? Can J Anaesth. 1998;45:802–8.
    1. Coastal Health Centre, Ellsworth ME, USA. Patient information sheet. Available from: [Last accessed on Feb 2005]
    1. American Medical Association. Code of ethics. Appointments changes. Available from: [Last accessed on Feb 2005]

Source: PubMed

3
Suscribir