Prevalence and cause of day of surgery cancelation in Tikur Anbesa Specialized Teaching Hospital, Addis Ababa, Ethiopia
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Date
2019-12
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Addis Ababa University
Abstract
Background: Day of surgery cancelation is elective surgical procedure that is not performed on the
planned day of surgery despite being on the finalized operating room schedule, for any reason. Day
of Surgery cancellation is a well-recognized quality problem and reflects inefficiency in management
of operating room time, manpower and hospital resources and one of the sensitive quality indicators
in perioperative care. Cancelation prevalence, major causes of cancellations, costs of surgical
procedure cancelation vary across countries, regions and hospitals. Point prevalence varies from
1.83% to 40%. Reasons for cancellations are complex because they are related to patients,
organizational issues, and clinical situations Cancellation of scheduled elective operations decreases
theatre efficiency and is inconvenient to the patients, their families and the medical teams
Objectives: To assess the prevalence and causes day of surgery cancellation and suggest solutions for
better patient management and effective utilization of resource in TASH.
Methods: This was hospital based prospective observational cross sectional study conductedin all
major operation rooms from June 1st to June 31 2019 GC. At TASH.the study subject were all
patients, of all ages, both genders, who were scheduled for elective surgical
operationsfromsurgicalspecialties (Cardiothoracic, General, Neuro, pediatric, orthopedic, Uro, Gyne,
obstetric) scheduled to undergo elective surgical operation.
Results: A total of 380patients were scheduled for elective surgeries during the study period, 266
patients had their operation performed at the scheduled time whereas 114(30%)patients were
cancelled at the day of surgery in which 68.4% were potentially avoidable. The most common causes
for cancellations were surgeon related accounts for 56 cases (49.1%) followed by administratorrelated
reasons, 41 (36% lowest was anesthesia related 3(2.6). lack of operating time due to
preceding long operation/unanticipated complication, overscheduling, surgeon not available
comprise about 70% of surgeon related cause whereaslack of OR material(36.6%), ICU bed(14.6%)
and mechanical ventilator(22%) were major cause of administrative related causes patient changed
mind after overnight fasting(35.7%) and acute change in medical condition(28.5%) were common
patient related factorsover all 68.4%(78/114) of cancellation was avoidable. The highest percentage
of cancellation related to the scheduled operations was in the NS 55.1% followed by CT and
orthopedics (53.3%, 34.4%) while the lowest was Gyne and urology (15%, 14.9%) respectively .Most
common cause of cancellation for NS and ortho was administrator 48% /5o% respectively followed
by surgeon related (NS, 37%) causes whereas in CT surgeon related was the commonest (75%)
Conclusions:Rate of cancelation is high in our setup which wastes the already limited resources
because most of causes are preventable each of the stake holders should take responsibility and
strive to decrease DOS cancelation. General understanding, communication and cooperation
between the surgical, anesthesiology, nursing, patient and logistic team will reducing the incidence t
a minimum and increase the efficacy of the hospital. Audit carried out at regular intervals to find out
the effective functioning of the OR and thorough assessment of feasibility and profitability of
approaches that have been proven to be successful in other institutions, in the context of our
institution characteristics and individual problems and taking proper administrative measures will
decrease cancelation and its attendant adverse events.
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Keywords
Day of surgery Cancellations, Elective surgical operations, causes of cancelation,avoidable, TASH.