Elective surgery cancellations due to suboptimal medicine management: a retrospective single site study

Background

Elective surgery cancellations and delays are associated with negative financial and staffing ramifications, adverse clinical outcomes, and poor patient outcomes. The Princess Alexandra Hospital in Brisbane, Australia, performs approximately 15 000 elective surgeries per year and medication optimisation is pivotal in preparing a patient for surgery to avoid same day of surgery theatre cancellations. Ideally, patients are seen in a multidisciplinary pre-admission clinic for optimisation of their health and medicines, and to provide education regarding their surgery.

Aim

To calculate the incidence of elective surgery cancellations due to medication misadventure over a 12-month period.

Method

A retrospective audit at a tertiary Queensland Hospital was conducted over a 12-month period (April 2021–March 2022), including patients who had their elective surgeries cancelled. The medical records from the hospital's digital databases for patients who were identified by the hospital coding service as ‘unfit for surgery’ were screened to see if the reason for the surgery cancellation was due to medication misadventure. The project was reviewed by the Metro South Human Research Ethics Committee and deemed exempt from further review (Ref No: CM20221651).

Results

The surgery cancellation rate was 50% (n = 6626 cancelled surgeries from 13 255 total surgeries booked). The same day of surgery cancellation rate was 5.5% (n = 734). Medication misadventure resulting from suboptimal medicine management was responsible for 1% (n = 66 out of 6626 surgery cancellations). A total of 41% (n = 27) of patients had their surgery cancelled ahead of time by the pharmacist due to a medication not being withheld for long enough, which prevented a same-day cancellation.

Conclusion

Having a pre-admission clinic pharmacist improves preoperative medication optimisation and has been proven to avoid same-day cancellations.