title: The effect of hospital size and surgical service on case cancellation in elective surgery: results from a prospective multicenter study.
abstract: BACKGROUND
  Short-term case cancellation causes frustration for anesthesiologists, surgeons, and patients and leads to suboptimal use of operating room (OR) resources. In many facilities, >10% of all cases are cancelled on the day of surgery, thereby causing major problems for OR management and anesthesia departments. The effect of hospital type and service type on case cancellation rate is unclear.
  
  
  METHODS
  In 25 hospitals of different types (university hospitals, large community hospitals, and mid- to small-size community hospitals) we studied all elective surgical cases of the following subspecialties over a period of 2 weeks: general surgery, trauma/orthopedics, urology, and gynecology. Case cancellation was defined as any patient who had been scheduled to be operated on the next day, but cancelled after the finalization of the OR plan on the day before surgery. A list of possible cancellation reasons was provided for standardized documentation.
  
  
  RESULTS
  A total of 6009 anesthesia cases of 82 different anesthesia services were recorded during the study period. Services in university hospitals had cancellation rates 2.23 (95% confidence interval [CI] = 1.49 to 3.34) times higher than mid- to small-size community hospitals 12.4% (95% CI = 11.0% to 13.8%) versus 5.0% (95% CI = 4.0% to 6.2%). Of the surgical services, general surgical services had a significantly (1.78, 95% CI = 1.25 to 2.53) higher cancellation rate than did gynecology services-11.0% (95% CI = 9.7% to 12.5%) versus 6.6% (95% CI = 5.1% to 8.4%).
  
  
  CONCLUSIONS
  When benchmarking cancellation rates among hospitals, comparisons should control for academic institutions having higher incidences of case cancellation than nonacademic hospitals and general surgery services having higher incidences than other services.
authors.affiliation: Department of Anesthesiology and Intensive Care, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Germany. martin.schuster@kliniken-lk.de
authors.forename: Martin
authors.initials: M
authors.lastname: Schuster
authors.forename: Christian
authors.initials: C
authors.lastname: Neumann
authors.forename: Konrad
authors.initials: K
authors.lastname: Neumann
authors.forename: Jan
authors.initials: J
authors.lastname: Braun
authors.forename: Goetz
authors.initials: G
authors.lastname: Geldner
authors.forename: Joerg
authors.initials: J
authors.lastname: Martin
authors.forename: Claudia
authors.initials: C
authors.lastname: Spies
authors.forename: Martin
authors.initials: M
authors.lastname: Bauer
mesh_terms: D000328:Adult; D000368:Aged; D001071:Appointments and Schedules; D017558:Elective Surgical Procedures; D005260:Female; D005858:Germany; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data*; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D009870:Operating Room Information Systems / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012044:Regression Analysis; D013043:Specialties, Surgical / Q000706:statistics & numerical data*; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D013997:Time Factors