Cancellations in day-case ENT surgery

Introduction:

In excess of two million operations are performed in a day-case/ambulatory setting in the United Kingdom each year. Cancellations in elective surgery cost the National Health Service (NHS) over £265 million per year.

Methodology:

This is a retrospective study in which the total number of elective ENT operations performed at The Guy's & St. Thomas’ NHS Trust in a 6-month period were investigated for a range of demographic factors including, age, gender and ethnicity with regards to their relationship to operative cancellation rates.

Results:

The overall cancellation rate was 19.9% (21.7% for females and 18.5% for males—this was statistically significant (p < 0.001)). There was a statistically significant difference between the three age groups (p < 0.001). There was a significant difference between the two commonest reasons for cancellation—“patient failed to arrive” and “patient unfit”. The cancellation rate for day-case operations was 11.4% and this was significantly lower than that for elective operations at 21.6% with (p < 0.001). The cancellation rates were 16.0% for Caucasians, 23.7% for blacks and 22.6% for Asians. There was a significant increase in cancellations during the winter months.

Discussion/recommendations:

Attention should be paid to subgroups at higher risk of operative cancellation (0 to 20-year olds, ethnic minorities, non-day case) especially in the winter months. The reason(s) for cancellation should be clearly recorded in the patient's notes. Medical staff at all levels should be given appropriate training as to the clinical significance of good note-keeping and its enforcement. The coding system for the classification of operative cancellations should be extensive and descriptive so as to include a broad range of categories.