Sociodemographic and Systems Risk Factors Associated With Nil by Mouth Noncompliance and Day-of-Procedure Cancellations: A Retrospective Multicenter Case-Control Study.

Abstract

Background: Day-of-procedure cancelations are a hardship, affecting patients, families, and health care systems. One major cause of cancelations is nil by mouth (nil per os [NPO]) noncompliance. Previous single-center studies show conflicting results regarding risk factors for cancelations. The primary objective of this study was to identify demographic populations with higher-than-predicted rates of NPO noncompliance, as defined by local institutional NPO guidelines. The secondary objective was to determine whether demographic and system risk factors were associated with procedure cancelations due to NPO noncompliance.

Methods: A multicenter retrospective case-control study was conducted of children <18 years of age presenting for elective procedures requiring adherence to local institutional NPO guidelines. Data collected included sociodemographic characteristics (age, sex, race-ethnicity, language of care, and medical insurance type) and systems factors (time of day for the scheduled procedure and communication modalities used to share NPO guidelines). The primary outcome was the occurrence of noncompliance of local institutional NPO guidelines. The secondary outcome was a cancelation of the elective procedure due to NPO noncompliance. A χ2 goodness-of-fit test and multivariable logistic regression were used for statistical analyses.

Results: Among 164,147 pediatric patients across 10 institutions, a total of 1208 instances of NPO noncompliance were identified (0.74%). Of the patients who experienced an NPO noncompliance event, 52% had their procedure delayed to a later time of the day, and 48% had their procedure canceled. Risk factors for NPO noncompliance included being younger than <4 years old, belonging to minority race-ethnicity groups, having Spanish as the primary language of care, and having public health insurance. In the multivariable analysis, the odds of cancelation after an NPO noncompliance event were 46% higher for children whose preprocedure phone call was not answered, 62% higher for children over 4 years old, 80% higher for non-Hispanic African American/Black children, 88% higher for children with public health insurance, and twice as high for procedures scheduled in the afternoon.

Conclusions: This multicenter study identified age, race-ethnicity, language of care, and health insurance type as factors associated with the occurrence of NPO noncompliance. Certain demographic and system risk factors were linked to higher rates of day-of-procedure cancelations due to NPO noncompliance. These findings raise concerns regarding disparities in access to care especially in minority populations already at an increased risk of inadequate health care access. Identifying these risk factors can help drive the development of strategies to address inequities and improve access to health care.