Last-Minute Cancellations in Pediatric Ambulatory and Day Surgeries in Italy: Prevalence and Risk Factors.

Abstract

Background: Cancellation of pediatric day and ambulatory surgeries on the day of the procedure poses a significant challenge, impacting hospital resources and patient care. In Italy, ambulatory surgery is defined as a surgical/diagnostic procedure without hospitalization, and day surgery is defined as a surgical/diagnostic procedure with daytime hospitalization.

Aims: To measure the rate and causes of cancellations on the day of the procedure in a tertiary pediatric hospital in Italy.

Methods: We collected the data retrospectively from the electronic health record between January 2020 and March 2022 at Ospedale Pediatrico Bambino Gesù in Rome, Italy. The number of case cancellations were captured. The reasons for cancellation were categorized into three different buckets: anesthetic reasons, surgical reasons, and non-adherence to protocol. The reasons under each of these categories were further explored. We analyzed the difference in the rate of last-minute cancellations between ambulatory surgery and day surgeries to examine if different pathways produce different results.

Results: A total of 4,600 procedures were scheduled and 183 were canceled (3.9% of total procedures). Surgical reasons contributed to most cancellations (49%), followed by anesthesia reasons (42%) and non-adherence to protocols (9%). Surgical reasons, including the need for post-operative hospitalization, were the primary causes for cancellation, often due to mismatches between pre-operative evaluations and the final decision-making process. Younger patients, particularly those prone to respiratory tract infections, were more likely to experience cancellations. Anesthetic reasons were also a significant factor but less prevalent than surgical ones.

Conclusions: Using standardized treatment and diagnosis pathways can reduce the number of canceled procedures and optimize resources. A telephone re-assessment before the procedure and telemedicine can be useful strategies to further reduce the cancellation rate.

Clinical implications: The use of pediatric day surgery has significant advantages: minimizing last-minute canceled procedures means increasing patient comfort and reducing healthcare costs. Identifying the causes of cancellations on the day of the procedure allows one to improve the organizational system of the operating room.