Impacts of elective surgical cancellations and postponements in Canada

Jordana L Sommer, Eric Jacobsohn, Renée El-Gabalawy, Jordana L Sommer, Eric Jacobsohn, Renée El-Gabalawy

Abstract

Purpose: Worldwide, patients experience difficulties accessing elective surgical care. This study examined the perceived health, social, and functional impacts of elective surgical cancellations and postponements in Canada.

Methods: We analyzed a subset of aggregate data from the Canadian Community Health Survey (CCHS) annual components from 2005 to 2014. Multivariable logistic regressions examined associations between past-year non-emergency surgical cancellations/postponements and perceived impacts of waiting for surgery (e.g., worry/stress/anxiety, pain, loss of work, loss of income, deterioration of health, relationships suffered).

Results: Among those who experienced a cancellation or postponement of a past-year non-emergency surgery (weighted n = 256,836; 11.8%), 23.5% (weighted n = 60,345) indicated their life was affected by waiting for surgery. After adjusting for type of surgery, year, and sociodemographics, those who experienced a surgical cancellation or postponement had increased odds of reporting their life was affected by waiting for surgery (adjusted odds ratio [aOR], 2.67; 99% confidence interval [CI], 1.41 to 5.1); in particular, they reported greater deterioration of their health (aOR, 3.47; 99% CI, 1.05 to 11.4) and increased dependence on relatives/friends (aOR, 2.53; 99% CI, 1.01 to 6.3) than those who did not have a cancellation or postponement.

Conclusion: Results highlight the multifaceted perceived impacts of surgical cancellations/postponements. These findings suggest there is a need for improvements in reducing elective surgical cancellations and postponements. Results may also inform the development of targeted interventions to improve patients' health and quality of life while waiting for surgery.

Keywords: cancellations and postponements; perceived impacts; surgery.

Figures

Figure
Figure
Surgical cancellations according to type of surgery

References

    1. Argo JL, Vick CC, Graham LA, et al. Elective surgical case cancellation in the Veterans Health Administration system: Identifying areas for improvement. Am J Surg. 2009;198:600–606. doi: 10.1016/j.amjsurg.2009.07.005.
    1. Caesar U, Karlsson J, Olsson LE, Samuelsson K, Hansson-Olofsson E. Incidence and root causes of cancellations for elective orthopaedic procedures: a single center experience of 17,625 consecutive cases. Patient Saf Surg. 2014 doi: 10.1186/1754-9493-8-24.
    1. Seim AR, Fagerhaug T, Ryen SM, et al. Causes of cancellations on the day of surgery at two major university hospitals. Surg Innov. 2009;16:173–180. doi: 10.1177/1553350609335035.
    1. Prin M, Eaton J, Mtalimanja O, Charles A. High elective surgery cancellation rate in Malawi primarily due to infrastructural limitations. World J Surg. 2018;42:1597–1602. doi: 10.1007/s00268-017-4356-1.
    1. Abeeleh MA, Tareef TM, Hani AB, et al. Reasons for operation cancellations at a teaching hospital: prioritizing areas of improvement. Ann Surg Treat Res. 2017;93:65–69. doi: 10.4174/astr.2017.93.2.65.
    1. Appavu ST, Al-Shekaili SM, Al-Sharif AM, Elawdy MM. The burden of surgical cancellations and no-shows: quality management study from a large regional hospital in Oman. Sultan Qaboos Univ Med J. 2016;16:e298–e302. doi: 10.18295/squmj.2016.16.03.006.
    1. Fayed A, Elkouny A, Zoughaibi N, Wahabi HA. Elective surgery cancelation on day of surgery: an endless dilemma. Saudi J Anaesth. 2016;10:68–73. doi: 10.4103/1658-354X.169479.
    1. Barua B, Jacques D. Waiting Your Turn: Wait Times for Health Care in Canada, 2018 report. Fraser Institute, 2018. Available from URL : (accessed September 2020).
    1. Lizaur-Utrilla A, Martinez-Mendez D, Miralles-Munoz FA, Marco-Gomez L, Lopez-Prats FA. Negative impact of waiting time for primary total knee arthroplasty on satisfaction and patient-reported outcome. Int Orthop. 2016;40:2303–2307. doi: 10.1007/s00264-016-3209-0.
    1. Salci L, Ayeni O, Farrokhyar F, Dao D, Ogilvie R, Peterson D. Impact of surgical waitlist on quality of life. J Knee Surg. 2016;29:346–354.
    1. Gregory DM, Temple Newhook J, Twells LK. Patients’ perceptions of waiting for bariatric surgery: a qualitative study. Int J Equity Health. 2013 doi: 10.1186/1475-9276-12-86.
    1. Oudhoff JP, Timmermans DR, Knol DL, Bijnen AB, van der Wal G. Waiting for elective general surgery: impact on health related quality of life and psychosocial consequences. BMC Public Health. 2007 doi: 10.1186/1471-2458-7-164.
    1. Nikolova S, Harrison M, Sutton M. The impact of waiting time on health gains from surgery: evidence from a national patient-reported outcome dataset. Health Econ. 2016;25:955–968. doi: 10.1002/hec.3195.
    1. Braybrooke J, Ahn H, Gallant A, et al. The impact of surgical wait time on patient-based outcomes in posterior lumbar spinal surgery. Eur Spine J. 2007;16:1832–1839. doi: 10.1007/s00586-007-0452-5.
    1. Sampalis J, Boukas S, Liberman M, Reid T, Dupuis G. Impact of waiting time on the quality of life of patients awaiting coronary artery bypass grafting. CMAJ. 2001;165:429–433.
    1. Pezold ML, Pusic AL, Cohen WA, et al. Defining a research agenda for patient-reported outcomes in surgery: using a Delphi survey of stakeholders. JAMA Surg. 2016;151:930–936. doi: 10.1001/jamasurg.2016.1640.
    1. Lavallee DC, Chenok KE, Love RM, et al. Incorporating patient-reported outcomes into health care to engage patients and enhance care. Health Aff (Millwood) 2016;35:575–582. doi: 10.1377/hlthaff.2015.1362.
    1. Ranganath VK, Strand V. Importance of ‘meeting of the minds’: patient-reported outcomes and MRI. Ann Rheum Dis. 2017;76:473–475. doi: 10.1136/annrheumdis-2016-210058.
    1. James Lind Alliance Priority Setting Partnership. Anaesthesia (Canada) Top 10. Available from URL: (accessed September 2020).
    1. Statistics Canada. Canadian Community Health Survey – Annual Component. Canadian Community Health Survey: Ottawa, ON; 2010. Available from URL: (accessed September 2020).
    1. Statistics Canada. Mitigation of risk to respondents of Statistics Canada’s surveys – June 2010; Retrieved from URL: (accessed September 2020).
    1. Statistics Canada. Frequently asked questions. 2019. Available from URL: (accessed September 2020).
    1. IBM Corp. IBM SPSS Statistics for Windows, Version 24.0 2016; Armonk, NY: IBM Corp.
    1. StataCorp. Stata Statistical Software: Release 14 2015; College Station, TX: StataCorp LP.
    1. Tait AR, Voepel-Lewis T, Munro HM, Gutstein HB, Reynolds PI. Cancellation of pediatric outpatient surgery: economic and emotional implications for patients and their families. J Clin Anesth. 1997;9:213–219. doi: 10.1016/S0952-8180(97)00032-9.
    1. Leslie RJ, Beiko D, van Vlymen J, Siemans DR. Day of surgery cancellation rates in urology: identification of modifiable factors. Can Urol Assoc J. 2013;7:167–173. doi: 10.5489/cuaj.1345.
    1. Herrod PJ, Adiamah A, Boyd-Carson H, et al. Winter cancellations of elective surgical procedures in the UK: a questionnaire survey of patients on the economic and psychological impact. BMJ Open. 2019 doi: 10.1136/bmjopen-2018-028753.
    1. Rasouli MR, Menendez ME, Sayadipour A, Purtill JJ, Parvizi J. Direct cost and complications associated with total joint arthroplasty in patients with preoperative anxiety and depression. J Arthroplasty. 2016;31:533–536. doi: 10.1016/j.arth.2015.09.015.
    1. Rodrigues HF, Furuya RK, Dantas RA, et al. Association of preoperative anxiety and depression symptoms with postoperative complications of cardiac surgeries (Portuguese) Rev Lat Am Enfermagem. 2018 doi: 10.1590/1518-8345.2784.3107.
    1. Mier N, Helm M, Kastenmeier AS, Gould JC, Goldblatt MI. Preoperative pain in patient with an inguinal hernia predicts long-term quality of life. Surgery. 2018;163:578–581. doi: 10.1016/j.surg.2017.09.055.
    1. Gerain P, Zech E. Informal caregiver burnout? Development of a theoretical framework to understand the impact of caregiving. Front Psychol. 2019 doi: 10.3389/fpsyg.2019.01748.
    1. Hunter DJ, Riordan EA. The impact of arthritis on pain and quality of life: An Australian survey. Int J Rheum Dis. 2014;17:149–155. doi: 10.1111/1756-185X.12232.
    1. Blyth FM, Noguchi N. Chronic musculoskeletal pain and its impact on older people. Best Pract Res Clin Rheumatol. 2017;31:160–168. doi: 10.1016/j.berh.2017.10.004.
    1. Ruiz ME. Risks of self-medication practices. Curr Drug Saf. 2010;5:315–323. doi: 10.2174/157488610792245966.
    1. Dexter F, Maxbauer T, Stout C, Archbold L, Epstein RH. Relative influence on total cancelled operating room time from patients who are inpatients or outpatients preoperatively. Anesth Analg. 2014;118:1072–1080. doi: 10.1213/ANE.0000000000000118.
    1. Pohlman GD, Staulcup SJ, Masterson RM, Vemulakonda VM. Contributing factors for cancellations of outpatient pediatric urology procedures: single centre experience. J Urol. 2012;188(4 Suppl):1634–1638. doi: 10.1016/j.juro.2012.03.111.
    1. Al Talalwah N, McIltrot KH. Cancellation of surgeries: integrative review. J Perianesth Nurs. 2019;34:86–96. doi: 10.1016/j.jopan.2017.09.012.
    1. Leite KA, Hobgood T, Hill B, Muckler VC. Reducing preventable surgical cancellations: Improving the preoperative anesthesia interview process. J Perianesth Nurs. 2019;34:929–937. doi: 10.1016/j.jopan.2019.02.001.
    1. Dawson VJ, Margo J, Blanco N, Munir WM. Reducing cancellations and optimizing surgical scheduling of ophthalmology cases at a veterans affairs medical center. J Healthc Qual. 2019;41:83–90. doi: 10.1097/JHQ.0000000000000187.
    1. Lee CM, Rodgers C, Oh AK, Muckler VC. Reducing surgery cancellations at a pediatric ambulatory surgery center. AORN J. 2017;105:384–391. doi: 10.1016/j.aorn.2017.01.011.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅