Cancellation of pediatric outpatient surgery: Economic and emotional implications for patients and their families

doi:10.1016/S0952-8180(97)00032-9

Journal of Clinical Anesthesia

Volume 9, Issue 3, May 1997, Pages 213-219

https://doi.org/10.1016/S0952-8180(97)00032-9 Get rights and content

Abstract

Study Objective: To determine the cause and timing of case cancellation in a pediatric outpatient surgical population, and to examine the economic and emotional impact of such cancellations on patients and their families.

Design: Questionnaire survey.

Setting: Outpatient surgery unit of a large university children's hospital.

Participants: 127 parents of children whose elective outpatient surgery had been cancelled.

Interventions: A total of 200 questionnaires were mailed to the parents of children who had their outpatient surgery cancelled.

Measurements and Main Results: Of those children whose surgery had been cancelled, 34.6% were due to upper respiratory infections (URIs), 30.7% for other medical reasons, and the balance for scheduling errors, because the child had not fasted, or for difficulties with transportation. The majority of surgeries (58.3%) were cancelled prior to their scheduled surgery date. However, 18.9% were cancelled on the day of surgery prior to leaving for the hospital and 22.8% were cancelled on arrival at the outpatient surgery clinic. Of those patients whose surgeries were not cancelled until they arrived at the hospital, 38.5% of mothers and 50.0% of fathers missed a day of work and, of these, 53.3% and 42.1%, respectively, went unpaid for the work day missed. The mean number of miles driven (round trip) to the hospital for a cancelled operation was 158.8 miles (range 8 to 1,350 miles). Additional testing and new appointments were ordered in 25.2% of the cancelled cases. 45% of parents and 16% of children were disappointed by the cancellation; 16% of parents were frustrated by the cancellation and 3.3% were angry.

Conclusions: This study suggests that last-minute cancellation of surgery has an important impact on patients and their families and suggests a need to review present protocols for screening patients prior to surgery.

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Case cancellation within 24 h was defined as cancelling a surgical procedure within 24 h of the scheduled date and time. Our candidate predictors were defined a priori and included patient-, procedural-, and appointment-related factors. We created a prediction tool using backward stepwise logistic regression to predict case cancellation within 24 h. The model was subsequently recalibrated and validated in a cohort of patients who were recently scheduled for surgery.
8.6% and 8.7% scheduled procedures were cancelled within 24 h of the intended procedure in the development and validation cohort, respectively. The final weighted score contains 29 predictors. A cutoff value of 15 score points predicted a 10.3% case cancellation rate with a negative predictive value of 0.96, and a positive predictive value of 0.21. The prediction model showed good discrimination in the development and validation cohort with an area under the receiver operating characteristic curve (AUC) of 0.79 (95% confidence interval 0.79–0. 80) and an AUC of 0.73 (95% confidence interval 0.72–0.73), respectively.
We present a validated preoperative prediction tool for case cancellation within 24 h of surgery. We utilize the instrument in our institution to identify patients with high risk of case cancellation. We describe a process for recalibration such that other institutions can also use the score to guide same day case cancellation reduction initiatives.
Wide-Awake Hand Surgery Experience in Patients 10 to 18 Years of Age
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However, surgery occasionally has to be postponed, as patients in the pediatric population are relatively more vulnerable to upper respiratory tract infections. Patients were reported to wait an average of 1 month until the next appointment in some cases.10 Besides, repeat tests of blood and radiography are sometimes necessary.10
We investigated the frequency of wide-awake local anesthesia no tourniquet (WALANT) use for hand surgery in the a 10- to 18-year–old age group and patients’ experiences.
Patients aged 10–18 years who had hand surgery in June 2016 to March 2020 were identified. The frequency of patients who agreed to have surgery under WALANT was calculated (%). Patients who received WALANT over the previous year were interviewed for their surgical experiences.
A total of 69 patients were identified, and 46 of them received WALANT. The mean age was 14.5 ± 2 years, and 22 of them were boys. Sixteen patients were called for a surgical experience assessment via questionnaire. They reported pain less than 1/10 during anesthesia injection and surgery. Ten patients (62%) found their operation easy, and 14 (87.5%) would prefer WALANT again.
This study showed that most patients in the 10–18 years age group accepted WALANT, and their surgical experiences were positive. For its advantages, WALANT should be considered in hand surgery for compliant patients in this age group.
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COVID-19 effects on operating room cancellations at a pediatric tertiary care hospital: A retrospective cohort study
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Same-day surgery cancellation results in decreased operating room (OR) utilization, reduced productivity, and inconvenience for patients. We aim to assess the cancellation rates of elective surgeries, identify common causes, and evaluate changes due to the COVID pandemic.
A retrospective cohort study was conducted identifying all same-day surgery cancellations at a tertiary pediatric academic hospital from 1/1/2015 to 12/31/2017 (pre-COVID) and from 4/1/2020 to 3/31/2021 (post-COVID). Statistical analysis was performed using generalized regression with cancellation as the dependent variable. Period, age, ethnicity, gender, preferred language, and insurance were independent variables.
There were 55465 scheduled cases (41670 before and 13795 after COVID), with 1508 cancellations (2.7%). Of those, 1247 (3.0%) were before COVID and 261 (1.9%) after COVID (p < .001). Of all cases, 56.7% (31475) were male, 55.1% (30595) were non-Hispanic/Latinx whites, 82.3% (45638) spoke English, and 45.5% (25237) had public insurance. The mean age was 8.5 years (SD = 6.03).
The decrease in the probability of cancellation was most significant in patients with public insurance, < 1 year-of-age, Hispanic/Latinx who spoke Spanish (pre-pandemic = 4.9% [CI = 4.2%–5.8%]; pandemic = 2.8% [95% CI = 1.9%–4.0%]. Regardless of the period, Hispanic/Latinx patients and those with public insurance had higher rates of surgery cancellations (p < .001).
There was a significant decrease in same-day cancellations post-pandemic. We hypothesize that the required pre-operative COVID test helped to minimize same-day cancellations. Increased communication and education enhanced family engagement and was critical for improved OR metrics, including cancellation rates.
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Pushing the Envelope: New Patients, Procedures, and Personal Protective Equipment in the Ambulatory Surgical Center for the COVID-19 Era
2021, Advances in Anesthesia
Citation Excerpt :
Methods of implementing social distancing in a health care facility include: limiting visitors to the facility to those essential for the patient’s physical or emotional well-being and care, encouraging the use of alternative communication devices (such as video-call applications or telemedicine), digital applications (apps), scheduling appointments to limit the number of patients in waiting rooms, and having patients wait in their vehicles until it is time for their procedure [68]. Telemedicine may improve surgery cancellation rates, reduce the likelihood of miles driven by patients or their family members, reduce the likelihood of patients or their family members missing days of work and wages unnecessarily, reduce unnecessary day of surgery testing, and may improve patient satisfaction and reduce facility expenditures [69–73]. The authors hypothesize that in the future, telemedicine may be further integrated into patient care with preanesthetic evaluations to facilitate the exponential growth of ambulatory procedures.
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A significant portion of each country's budget is assigned to its health care system annually. Given the current economic conditions, saving costs is a key issue. Therefore, any situation that leads to lower efficiency and higher costs should be remedied. With much of the hospitals' budgets spent on operating rooms, it is important to use strategies to increase their efficiency and quality. The purpose of this study is to design a mechanism to reduce the cancellation of elective surgical procedures, which incurs considerable costs.
To this end, the data gathered from an educational hospital in Tehran were evaluated. The reasons for the surgical cancellations were determined through data analysis and process identification. Subsequently, considering the contents of the current literature and consultations with the hospital staff, suggestions were made to reduce surgical cancellations. Finally, using a solution allocation model, the best solution in terms of costs, efficiency, and implementation time was assigned by using the Fuzzy Extended Analytical Hierarchy Process to each of the reasons and surgeries.
By solving the allocation model using the GAMs software, the solutions were assigned to specific reasons and surgeries. This solved model assigns the best solutions to cancellation reasons regarding solutions cost, efficiency and implementation time.
The cancellation of the six investigated surgeries alone imposes on the hospital approximately 1165,653,450 rials annually, so it is true to assume that, in general, reducing the cancellation of surgery can reduce hospital costs considerably.
Global prevalence and reasons for case cancellation on the intended day of surgery: A systematic review and meta-analysis
2020, International Journal of Surgery Open
Cancellation of operation on the intended day of surgery affects the efficiency of Operation Room which incurs a significant financial loss for the patient, hospital, and health care cost of a country at large. This systematic and Meta-Analysis was intended to provide evidence on the global prevalence and determinants of case cancellation on the intended day of surgery.
A comprehensive search was conducted in PubMed/Medline; Science direct and LILACS from January 2010 to May 2020 without language restriction. The Heterogeneity among the included studies was checked with forest plot, χ2 test, I2 test, and the p-values. All observational studies reporting prevalence and determinants were included.
A total of 1207 articles were identified from different databases with an initial search. Fort-eight articles were selected for evaluation after the successive screening. Thirty-three Articles with 306,635 participants were included. The Meta-Analysis revealed that the global prevalence of case cancellation on the intended day of surgery was 18% (95% CI: 16 to 20). The Meta-Analysis also showed that lack of operation theatre facility accounted for the major reason for cancellation followed by no attendant and change in medical condition.
The meta-analysis revealed that the prevalence of case cancellation was very high in low and middle-income countries and the majorities were avoidable which entails rigorous activities on operation theatre facilities, preoperative evaluation and preparation, patient and health care provider communications.
This Systematic Review and Meta-Analysis was registered in a research registry (researchregistry5746) available at https://www.researchregistry.com/browse-the-registry#home/

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^☆: Supported in part by National Institutes of Health Grant GM 39505.

^∗: Associate Professor of Anesthesia.

^†: Clinical Nurse Specialist.

^§: Assistant Professor of Anesthesia; Research Investigator, Mental Health Research Institute.

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Original contributionCancellation of pediatric outpatient surgery: Economic and emotional implications for patients and their families☆

Abstract

Int J Nurs Stud

Nurs Clin No Am

J Clin Anesth

J Clin Anesth

AORN J

J Clin Epidemiol

AORN J

Outpatient clinic nonarrivals and cancellations

NZ Med J

Understanding non-attendance in outpatient paediatric clinics

Arch Dis Child

Original contribution
Cancellation of pediatric outpatient surgery: Economic and emotional implications for patients and their families☆