Danyal Shiraz, Tahir Naeem, Muhammad Salman Rafiq, Mah Muneer Khan.
Cancelled and postponed elective cases in general surgery.
Pak J Surg Nov ;32(3):162-7.

Introduction: Cancellation and postponement of elective cases wastes time and resources. This audit was conducted to study elective general surgery cases which are postponed or cancelled. Study design: Retrospective observational study. Materials and methods: Th is audit was conducted at the Department of Surgery Khyber Teaching Hospital, Peshawar from June 2015 to January 2016. A total of 616 patients were analysed over the study period. Th e elective list and reasons for postponement and cancellation were collected on each operative day. In addition patient charts and notes were utilised. Results: Of the total 616 patients who were operated during the audit period on the elective list, there were 266(43.2%) males and 350(56.8%) females. Th e average age was 42.13±13.1 years. A total of 616 elective patients were booked for surgery in four operation theatres by the same unit. 69(11.2%) patients were postponed or cancelled on the elective list. Among reasons for postponement or cancellation were 17(2.8%) due to fitness related issues, 11(1.8%) due to lack of operating room time, in 12 (1.9%) patients the initial operative plan was changed, 7(1.1%) for logistical and shifting reasons, 7(1.1%) had incomplete patient investigations and data, 6(1%) were not adequately prepared pre-operatively, 3(0.5%) refused consent and 1(0.2%) patients failed to show up for their surgery. In addition in 3(0.5%) cases instruments were not available and in 2(0.3%) cases the surgeon was not available. Among the reasons for lack of fitness for surgery 6(1%) had hypertension, 5(0.8%) patients had chest related pathologies, 2(0.3%) patients had deranged liver function and there was 1 patient each; 1(0.2%) non fit for surgery due to uncontrolled Diabetes, low Hemoglobin, coagulation defects and infection related complications. Of the 69(11.2%) cases postponed or cancelled, 60(87%) were cancelled on the operative day and 9(13%) were postponed or cancelled on the day prior. 49(8%) of the postponed or cancelled patients were for potentially avoidable reasons. Conclusion: Th e present audit highlighted deficiency in all aspects related to elective patient preparation, operation, treatment and discharge. Th e leading causes for postponement or cancellation were non-fitness for surgery, change of surgical plan, lack of operation theatre time, logistical reasons and incomplete patient data. Analysis of data revealed that the majority of these factors were potentially avoidable. Th e audit recommends improvements to all aspects of patient management. Applying these recommendations the number of cases postponed or cancelled will fall considerably.

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