Same-day cancellation of cardiac surgery: a retrospective review at a large academic tertiary referral center.
BACKGROUND
Same-day cancellations of cardiac surgery are unfortunate and costly occurrences that potentially place patients at risk of adverse events.


METHODS
We retrospectively reviewed all same-day cancellations of cardiac operations requiring cardiopulmonary bypass from 2010 to 2012 at a large academic tertiary referral center.


RESULTS
Of 7081 cardiac operations, 134 patients experienced 142 same-day cancellations of cardiac surgery. The foreseeable cancellation causes comprised 17% of cancellations, nonforeseeable 59%, and indeterminate 24%. The reasons for cancellation were medical (51%), administrative or scheduling (17%), unknown (12%), procedure no longer required (11%), patient cancellation (6%), and preincisional complication (3%). The mean interval from the patient seeing a nonsurgeon provider to cancellation was 8.6 ± 16.2 days. No statistically significant differences existed between the foreseeable and nonforeseeable cancellations and the timing of the visit to a nonsurgeon provider (15, 30, 45, and 60 days) before cancellation. Seven patients (5%) had died within 30 days of cancellation. Of those subsequently operated on, the mean interval from cancellation to performance of the operation was 12.2 ± 22.7 days. Of the 142 cancelled surgical procedures, 28 (20%) were never subsequently performed.


CONCLUSIONS
Same-day cancellation of cardiac surgery occurred infrequently (2% of cardiac operations performed) at our institution. The cancellations were for foreseeable causes in a few cases. Seeing a nonsurgeon provider more recently before cancellation was not significantly associated with nonforeseeable versus foreseeable cancellations. Although uncommon at our institution, same-day cancellations should be viewed as an opportunity for practice improvement, given the foreseeable nature of some cancelations, associated 30-day mortality, and portion of patients not subsequently undergoing cardiac surgery.
Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minn.
Mark M
MM
Smith
Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minn.
William J
WJ
Mauermann
Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minn; Center for the Science of Health Care Delivery, Mayo Clinic College of Medicine, Rochester, Minn.
David J
DJ
Cook
Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minn; Department of Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, Minn.
Joseph A
JA
Hyder
Division of Cardiovascular Surgery, Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minn.
Joseph A
JA
Dearani
Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minn; Department of Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, Minn. Electronic address: Barbara.David@mayo.edu.
David W
DW
Barbara
D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001071:Appointments and Schedules; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002315:Cardiopulmonary Bypass; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D061665:Time-to-Treatment; D055815:Young Adult