title: A 5-year observational study of cancellations in the operating room: Does the introduction of preoperative preparation have an impact?
abstract: BACKGROUND
  Preoperative preparation (assessment) of patients reduces cancellations on the day of surgery. A Center for Reviews and Dissemination review (2007) concluded "the evidence was weak and it was uncertain that preassessment reduced cancellations." The aim of this study was to observe the impact of a preoperative preparation clinic on cancellations of operating room cases on the day of surgery, and in particular on those causes of cancellation on the day of surgery which were expected to be affected by preoperative preparation.
  
  
  METHODS
  Observational study conducted in a 194 bed District General Hospital in the United Kingdom from April 1, 2006 to March 31, 2011. 42,082 operating room cases were scheduled for operation during this period. Surgical sessions which did not require anesthetic input were excluded. Contemporaneous data were collected and analyzed on a monthly basis, and also grouped by year over a 5-year period. The cancellations on the day of surgery were divided into two groups: Those considered to be affected by preoperative preparation and those which were not. Comparisons were made between these two groups and between individual reasons for cancellation.
  
  
  RESULTS
  A total of 28,928 cases met the inclusion criteria. The clinic introduction reduced cancellations considered to be affected by preoperative preparation from 462 to 177 (78% and 42% total cancellations, respectively) (P < 0.001). There was a decrease in cancellations due to patients who did not arrive (P < 0.001) and medical reasons (P < 0.001), but an increase in the number of cancellations by the patients themselves (P = 0.002). Cancellations due to lack of beds and "other" reasons both increased (P < 0.001) across the study period.
  
  
  CONCLUSIONS
  This study suggests that the introduction of preoperative preparation clinics for patients reduces cancellations on the day of surgery.
authors.affiliation: Department of Anesthesia, Dr. Gray's Hospital, Elgin, United Kingdom ; School of Medicine and Dentistry, Dr Gray's Hospital, Elgin, United Kingdom.
authors.forename: Douglas R A
authors.initials: DR
authors.lastname: McKendrick
authors.affiliation: School of Medicine and Dentistry, Dr Gray's Hospital, Elgin, United Kingdom ; Department of Obstetrics and Gynecology, Dr Gray's Hospital, Elgin, United Kingdom ; University of the Highlands and Islands, United Kingdom.
authors.forename: Grant P
authors.initials: GP
authors.lastname: Cumming
authors.affiliation: Medical Statistics Team, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Lee
keywords: Anesthesia; assessment; cancelled procedures; preoperative care