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One in seven operations cancelled on day of surgery, study finds

BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3767 (Published 06 September 2018) Cite this as: BMJ 2018;362:k3767
  1. Ingrid Torjesen
  1. London, UK

Ongoing pressure on NHS hospitals resulted in cancellation of one in seven operations on the day they were due to take place in one week in March last year, researchers have found.1

The research group, led by the Health Services Research Centre at the Royal College of Anaesthetists and the UCL Surgical Outcomes Research Centre, examined the factors associated with last minute cancellations. Their observational cohort study used data from 245 hospitals (more than 90% of NHS hospitals across England, Wales, Scotland, and Northern Ireland) during one week in March 2017.

They found a total of 26 171 inpatient operations scheduled to take place between 21 and 27 March. Of these, 3724 were cancelled or postponed on the day of surgery—377 (10.1%) because of insufficient bed capacity and 1029 (27.6%) for clinical reasons. In 2110 cases (56.7%) no reason for cancellation was specified.

A 10th (1499) of the 14 936 patients who were to undergo elective, non-emergency inpatient surgery had had the same operation cancelled at least once before. Where operations had been cancelled previously, insufficient bed capacity (31% of cancellations), insufficient operating theatre capacity (12.7% of cancellations), and other potentially avoidable non-clinical reasons, such as staff shortages or equipment failure, accounted for around half the total number of cancellations. Clinical reasons accounted for 33% of the cancelled operations.

The findings, published in the British Journal of Anaesthesia, show that operations at hospitals with an emergency department were five times as likely to be cancelled (odds ratio 4.18 (95% confidence interval 2.22 to 7.89); P<0.001). Patients who were medically fit for surgery were three times as likely to have elective, non-emergency operations cancelled if they needed critical care afterwards (OR 2.92 (2.1 to 4.02); P<0.001).

Last minute cancellation was less likely among patients undergoing obstetric procedures (OR 0.16 (0.08 to 0.32); P<0.001), expedited surgery (OR 0.39 (0.27 to 0.56); P<0.001), and cancer surgery (OR 0.32 (0.22 to 0.46); P<0.001).

The study did not look at cancellations in 2018. But data from NHS England show that in the first quarter of 2018-19 a total of 25 475 operations were cancelled on the day of surgery, the highest quarterly figure since records began in 1994.

The study’s chief investigator, Ramani Moonesinghe, from University College London, said, “There are no easy answers, but an important next step would be for hospitals to look into the reasons for cancellations locally and for researchers to investigate the potential benefits of different solutions. This could include evaluating how the separation of emergency and elective services in some hospitals or specialties might reduce cancellations and improve efficiency.”

Liam Brennan, president of the Royal College of Anaesthetists, said, “We fully support working with all relevant specialties to better understand the reasons for this widespread problem with the aim of developing an action plan to reduce clinical and non-clinical cancellations.”

Responding to the study, Cliff Shearman, vice president of the Royal College of Surgeons, said, “Patients on the waiting list for planned treatments, such as heart or hip operations, continue to feel the brunt of pressures in the NHS. More needs to be done to improve hospital capacity, potentially increasing bed numbers in some parts of the country, if we are to make a serious effort at stemming the rising numbers of patients having their operations cancelled.”

NHS Providers’ chief executive, Chris Hopson, said, “No trust wants to cancel operations. This is often disruptive and distressing for patients and adds to waiting list pressures for trusts which are already overstretched.”

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