title: Incidence and root causes of cancellations for elective orthopaedic procedures: a single center experience of 17,625 consecutive cases.
abstract: BACKGROUND
  The purpose of the Swedish public health-care system is to provide care on equal terms for all citizens. In this, as in most other systems where taxes and/or insurances pay for most of the care, normal market forces are set aside at least in part. At times, this has, for example, resulted in long waiting lists, particularly in terms of elective orthopaedic surgery, with several negative consequences, such as cancellations of planned surgery.
  
  
  METHODS
  The main purpose of this retrospective observational single center study was to evaluate and describe the number and reasons for cancellations in elective orthopaedic surgery. Studied were all the elective patients scheduled for joint replacement, arthroscopy and foot & ankle surgery, January 1, 2007 to December 31, 2011, whose procedure was cancelled at least once.
  
  
  RESULTS
  Of all 17,625 patients scheduled for elective surgery 6,911 (39%) received at least one, some several cancellations. The most common reason for cancelling a planned surgery was different patient-related factors 3,293 (33%). Cancellations due to treatment guarantee legislation reached 2,885 (29%) and 1,181 (12%) of the cancellations were related to incomplete pre-operative preparation of the patients. Organisational reasons were the cause of approximately 869 (9%) of the cancellations.
  
  
  CONCLUSIONS
  In this study of patients waiting for elective orthopaedic surgery 6,911(39%) had their surgical procedure cancelled at least once, some several times. It appears that it should be possible to eliminate many of these cancellations, while others are unavoidable or caused by factors outside the responsibility of the individual clinic or even hospital. One possible way of influencing the high rate of cancellations might be to change the view of the patients and involve them in the overall planning of the care process.
authors: Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Sahlgrenska University Hospital, SE- 413 45 Gothenburg, Sweden.
authors: Ulla
authors: U
authors: Caesar
authors: Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Sahlgrenska University Hospital, SE- 413 45 Gothenburg, Sweden.
authors: Jon
authors: J
authors: Karlsson
authors: Institute of Health and Care Sciences Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors: Lars-Eric
authors: LE
authors: Olsson
authors: Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Sahlgrenska University Hospital, SE- 413 45 Gothenburg, Sweden.
authors: Kristian
authors: K
authors: Samuelsson
authors: Institute of Health and Care Sciences Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors: Elisabeth
authors: E
authors: Hansson-Olofsson
keywords: Appointments and schedules; Cancellation; Operating rooms/organisation and administration; Orthopaedic surgery; Perioperative nursing; Waiting lists