Last-minute cancellation of elective lung cancer surgery is associated with poorer survival.

Abstract

Objectives: Our objective was to assess the incidence and reason of last-minute cancellations before surgery for lung cancer and their association with outcomes.

Methods: Retrospective analysis on all consecutive patients booked for elective lung cancer surgery from January 2017 through December 2022 in a single centre. Last-minute cancellation: a cancellation occurring within the last 24 h from the planned operation. Cancellation categories: process-related and patient-related. The short-term and long-term outcomes of patients who experienced a last-minute cancellation were analysed.

Results: 197 patients of 1587 (12%) had a last-minute cancellation: 156 (79%) were process-related and 41 (21%) were patient-related. Three percent (5/156) of patients cancelled for process reasons did not receive surgery versus 39% (16/41) of those cancelled for patient-related reasons, P < 0.0001. The 90-day mortality rates of cancelled and non-cancelled patients were similar (4.6% vs 4.7%, P = 1). Five-year overall survival of patients with cancellation was 58% (95% confidence interval 49-66) vs 69% (95% confidence interval 66-71) of those without cancellations, P = 0.022. Among those who had a cancellation, the 5-year overall survival of those with process-related cancellations was 61% (52-60) vs 35% (14-58) of those with patient-related cancellations (adjusted P value for multiple comparisons = 0.14). Cox regression analysis showed that surgery cancellations within the last 24 h for patient-related (hazard ratio 1.87, 95% confidence interval 1.02-3.42, P = 0.043) reasons remained a factor associated with poorer overall survival after adjusting for clinical stage, type of operation and patient-related variables.

Conclusions: Implementing the patient's preoperative clinical evaluation to reduce the occurrence of related last-minute cancellations might mitigate its negative impact on survival.