Cancellations in Cardiac Surgery: Predictable, Dangerous and Avoidable?

Edward J. Caruana ¹, Katerina Konstantinidi ², Pete Allsopp ¹, Sally Highton ¹, Adam Szafranek ¹, Selveraj Shanmuganathan ¹

¹ Nottingham University Hospitals, Nottingham, United Kingdom; ² Medical School, Nottingham University, Nottingham, United Kingdom;

Date, time and location: 2018.05.25 13:30, Exhibition area, 1st Floor. Zone – D

Abstract

Objectives

Theatre cancellations are costly, distressing to patients, and may result in poorer outcomes. We sought to evaluate the determinants, incidence, outcomes and documentation practices surrounding cardiac surgical theatre cancellations at a single UK institution.

Methods

Patients cancelled following final theatre listing, between March 2016 and February 2017, were identified from administrative databases. Cancellation data was collected retrospectively from individual case-records, and documentation practices audited against the AAGBI Guidelines on Theatre Efficiency (2003). Perioperative and survival data was obtained from national databases. Statistical analysis was performed in Analyse-it for Microsoft Excel.

Results

487 (94.2%) non-emergent procedures were performed, with 45 cancellations in 43 patients (cancellation rate: 9.2%); and resulting in a 16% increase in interval wait from angiogram to surgery. Only 6 cancellations (13.1%) were documented in full accordance with the relevant guidance.

Age (p=0.88), gender (p=0.38) and EuroSCORE II (p=0.60), day of the week (p=0.14) and consultant surgeon (p=0.29) had no impact on likelihood of cancellation. Cancellation rates varied by month (p=0.038, highest in January (19.4%) and lowest in October (2.1%)). 82% (n=37) of cancellations were due to hospital-causes; primarily bed-staffing availability (40.5%) and emergency cases (37.8%). Cancellation was associated with a higher in-hospital mortality (n=3) (6.7 vs 1.6%, p =0.044), but this normalised 6 months post-operatively (p=0.19). 5 cancellations (11.1%) were foreseeable and preventable.

Conclusions

Surgical cancellations are common, with only a small proportion being foreseeable and preventable. Documentation practices surrounding cancellations are poor. Cancellation may be associated with poorer short-term outcome; however, this effect needs further evaluation in a larger cohort.