title: Reasons for cancellation of elective cardiac surgery at Prince Sultan Cardiac Centre, Saudi Arabia.
abstract: The cancellation of surgery is a significant drain on health resources. However, a persistent problem in most hospitals is short notice cancellation of scheduled operations, even upto the day of surgery. In some cases, patients have been prepared for surgery, and the staff is assembled and expecting to operate. In UK 8% of scheduled elective operations are cancelled within 24 hours of surgery. The reasons include cancellation by the patient, cancellation for poorly optimized medical conditions, or cancellations due to poor organization. Many of these are difficult to quantify. However, one relatively easily measured factor is the possibility that some operating lists were predictably over-booked. An operating list may over-run because of delayed starts, slow turnover, unanticipated surgical/anaesthetic problems or staff shortages. Many of these are difficult to quantify.
  
  
  OBJECTIVE
  Prince Sultan Cardiac center is one of the largest referral center in the Middle East and there is no published data on the reasons for cancellation of specifically cardiac procedures. However, an audit was performed to assess the reasons for the cancellation of the cases on the day of surgery in cardiac theatres. According to one of the studies published in an Australian journal the percentage of cancelled cardiothoracic cases was determined to be 15.8%.
  
  
  RESULTS
  Total number of cardiac surgical patients including pediatric and adult during a period from June 2008 to May 2009 were 2191. Out of those, 1681 cases were done during the study period, 510 (23.27%) cases were cancelled during the study period. The operation theatre was functional for 331 days during the study period. Cancellations done by the surgeons were 34% while the patient's related cancellations were 32%. The administrative issues contributed to 34% in overall cancellation and anaesthetist-related cancellation were 0%.
  
  
  CONCLUSIONS
  We estimated 22% of the elective operations which were cancelled on the day of surgery were potentially avoidable. There is still a need to do further research to look for the identifiable reasons and strategic measures to eliminate the reasons for cancellation on the day of surgery.
authors: Leicester Royal Infirmary, Leicester UK; Saudi Arabia.
authors: Nabeel
authors: N
authors: Sultan
authors: Abdul
authors: A
authors: Rashid
authors: Syed M
authors: SM
authors: Abbas
keywords: Anaesthetic problems; Cancellations; Cardiac theatres; Health resources; Interventions; Operating suites; Over-booked; Over-run; Poor organization
references: Anaesthesia. 2006 Aug;61(8):768-76
references: 16867090
references: Anesthesiology. 1996 Dec;85(6):1232-4
references: 8968168
references: J R Coll Surg Edinb. 1998 Jun;43(3):178-81
references: 9654879
references: Br Dent J. 1991 Oct 19;171(8):244-5
references: 1804271
references: Rev Lat Am Enfermagem. 2000 Aug;8(4):59-65
references: 11235240
references: J Health Organ Manag. 2007;21(1):54-8
references: 17455812
references: Anesth Analg. 1999 Aug;89(2):502-5
references: 10439775
references: J Med Syst. 1997 Oct;21(5):309-22
references: 9507407
references: Anesthesiology. 1999 Apr;90(4):1176-85
references: 10201692
references: J Ayub Med Coll Abbottabad. 2007 Jul-Sep;19(3):64-6
references: 18444594
references: Anesth Analg. 2001 Jun;92(6):1493-8
references: 11375832
references: Health Trends. 1991;23(3):115-6
references: 10171063
references: Med J Aust. 2005 Jun 20;182(12):612-5
references: 15963016
references: Ir J Med Sci. 2004 Jul-Sep;173(3):129-32
references: 15693380
references: Int J Clin Pract. 1997 Jul-Aug;51(5):294-5
references: 9489087
references: Ugeskr Laeger. 1991 Jun 3;153(23):1657-8
references: 2058031
references: Health Trends. 1991;23(3):114-5
references: 10171062
references: Anesth Analg. 1998 Apr;86(4):896-906
references: 9539621
references: Anaesth Intensive Care. 1995 Oct;23(5):591-6
references: 8787260
references: Anesth Analg. 2003 Oct;97(4):1119-1126
references: 14500168
references: Crit Care Med. 2004 Apr;32(4 Suppl):S76-86
references: 15064666
references: J Nurs Manag. 2002 Mar;10(2):75-81
references: 11882108
references: Br J Anaesth. 2001 Jun;86(6):789-93
references: 11573584
references: J Clin Anesth. 1997 May;9(3):213-9
references: 9172029
references: Tidsskr Nor Laegeforen. 2001 Sep 10;121(21):2516-9
references: 11875930
references: J Clin Epidemiol. 1995 Apr;48(4):485-9
references: 7722602