Same-day cardiac surgery cancellations at a large UK centre and patient satisfaction survey

Authors

  • Sara Jasionowska Department of Cardiothoracic Surgery, St Bartholomew’s Hospital, London, United Kingdom
  • Rory F. L. Hammond Department of Cardiothoracic Surgery, St Bartholomew’s Hospital, London, United Kingdom
  • Wael I. Awad Department of Cardiothoracic Surgery, St Bartholomew’s Hospital, London, United Kingdom

DOI:

https://doi.org/10.18203/2349-2902.isj20205870

Keywords:

Cardiac surgery, Patient satisfaction, Service improvement, Surgery cancelation

Abstract

Background: Same-day cancellation of cardiac surgeries is a disheartening experience for patients. The primary aims of this study were to determine the frequency and reasons for same-day cancellations, and associated patients’ outcomes. The secondary aims were to evaluate patients' reactions to cancellations and to propose measures to reduce cancellations.

Methods: We prospectively reviewed all elective and urgent in-patient adult cardiac surgeries performed from August 2017 to March 2018. Procedures were divided into cancelled (C) and not cancelled (NC) groups. A qualitative patient satisfaction survey was undertaken.

Results: Overall, 1388 patients were scheduled for cardiac surgery during this period. Elective surgeries constituted 70.7% (981/1388) and urgent 29.3% (407/1388). 231/1388 (16.7%) procedures were cancelled for the following reasons: 30.5% lack of ITU beds, 20.1% patient medically unfit, 8.2% ITU staff shortage, 6.9% emergency case intervention and 34.2% other. There was no significant difference in mortality between groups (2.6% in C versus 1.6% in NC, p=0.62). In group C, 36% (84/231) of patients underwent surgery within 72 hours of cancellation, 47% (110/231) of procedures were rescheduled, and 6.9% (16/231) were not performed. 30.7% (71/231) were potentially preventable. All cancelled patients were asked to complete the survey; 43.7% (101/231) responded, with 22.8% (23/101) describing feeling upset. However, 92.1% (93/101) felt the cancellation was justified.

Conclusions: This single institutional study suggests a relatively high number of planned same-day surgeries are being cancelled. A third of these may be preventable. Despite this, patients were understanding. Actions to decrease cancellations should be identified to improve efficiency.

Author Biography

Sara Jasionowska, Department of Cardiothoracic Surgery, St Bartholomew’s Hospital, London, United Kingdom

Research Assistant, St Bartholomew's Hospital

References

Dimitriadis P, Iyer S, Evgeniou E. The challenge of cancellations on the day of surgery. Int J Surg. 2013;11(10):1126-30.

Cardiothoracic Surgery- Getting It Right First Time - GIRFT. Getting It Right First Time - GIRFT. 2020 Available from: https://gettingitrightfirsttime.co.uk/surgical-specialty/cardiothoracic-surgery/. Accessed on 16 June 2020.

Ivarsson B, Larsson S, Sjoberg T. Postponed or cancelled heart operations from the patient's perspective. J Nurs Manag. 2004;12(1):28-36.

Kaddoum R, Fadlallah R, Hitti E, EL-Jardali F, El Eid G. Causes of cancellations on the day of surgery at a Tertiary Teaching Hospital. BMC Health Serv Res. 2016;16(1).

Smith M, Mauermann W, Cook D, Hyder J, Dearani J, Barbara D. Same-day cancellation of cardiac surgery: A retrospective review at a large academic tertiary referral center. J Thorac Cardiovasc Surg. 2014;148(2):721-5.

Argo J, Vick C, Graham L, Itani K, Bishop M, Hawn M. Elective surgical case cancellation in the Veterans Health Administration system: identifying areas for improvement. Am J Surg. 2009;198(5):600-6.

Schofield W, Rubin G, Piza M, Lai Y, Sindhusake D, Fearnside M et al. Cancellation of operations on the day of intended surgery at a major Australian referral hospital. Med J Austral. 2005;182(12):612-5.

González-Arévalo A, Gómez-Arnau J, delaCruz F, Marzal J, Ramírez S, Corral E et al. Causes for cancellation of elective surgical procedures in a Spanish general hospital. Anaesthesia. 2009;64(5):487-93.

Kumar R, Gandhi R. Reasons for cancellation of operation on the day of intended surgery in a multidisciplinary 500 bedded hospital. J Anaesthesiol Clin Pharmacol. 2012;28(1):66.

Ezike H, Ajuzieogu V, Amucheazi A. Reasons for elective surgery cancellation in a referral hospital. Ann Med Health Sci Res. 2011;1(2):197-202.

Ogrinc G, Davies L, Goodman D, Batalden P, Davidoff F, Stevens D. SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process: Table 1. BMJ Qual Saf. 2015;25(12):986-92.

Wasim A, Shahban S, Goswami V. Hospital policy following cancelled orthopaedic surgery and the patient experience- making the best of a bad situation. J Hosp Manag Health Policy. 2018;2:48.

O’Malley N, Sproule J, Nicholson P, Rice J, McElwain J. Ring-fencing- bed protection for the patient. Irish J Med Sci. 2005;174(S1):49.

Coyle D, Lowery AJ, Khan W, Waldron R, Barry K. Successful introduction of ring-fenced inpatient surgical beds in a general hospital setting. Ir Med J. 2012;105(8):269-71.

Whiteley MS, Wilmott K, Offland RB. A specialist nurse can replace pre-registration house officers in the surgical pre-admission clinic. Ann R Coll Surg Engl. 1997;79(6):257-60.

Hines S, Munday J, Kynoch K. Effectiveness of nurse-led preoperative assessment services for elective surgery: a systematic review update protocol. JBI Database Systemat Rev Implement Rep. 2013;11(9):73-83.

Pollard J, Olson L. Early outpatient preoperative anesthesia assessment. Anesth Analg. 1999;89(2):502-5.

Turunen E, Miettinen M, Setälä L, Vehviläinen-Julkunen K. Elective surgery cancellations during the time between scheduling and operation. J PeriAnesth Nurs. 2019;34(1):97-107.

Pandit J, Carey A. Estimating the duration of common elective operations: implications for operating list management. Anaesthesia. 2006;61(8):768-76.

Downloads

Published

2020-12-28

Issue

Section

Original Research Articles