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Factors inuencing the cancellation of Factors inuencing the cancellation of
scheduled surgeries: a literature reviewscheduled surgeries: a literature review
Factores que inuyen en la cancelación de cirugías Factores que inuyen en la cancelación de cirugías
programadas: una revisión de la literaturaprogramadas: una revisión de la literatura
Stephanye Carrillo Gonzalez
a
Jaime Lorduy Gómez
b
Verónica Castro Bocanegra
c
Álvaro Quintana Salcedo
d
Ruby Muñoz Baldiris
e
Mónica Ramos Herrera
f
a
Surgical Instrument Technician- Master´s Degree in Bioethics – Professor at Rafael Núñez University Corporation - Surgical Instrument
Technician Program. Cartagena, Bolivar, Colombia.
b
Bacteriologist, Specialist in Microbiology, Master´s Degree in Epidemiology- Professor at Rafael Núñez University Corporation – Surgical
Instrument Technician Program, Cartagena, Bolivar, Colombia.
c
Surgical Instrument Technician, Master´s Degree in Public Health - Professor at Rafael Núñez University Corporation - Surgical Instrument
Technician Program. Cartagena, Bolivar, Colombia.
d
Dentist, Specialist in International Cooperation for Development, Master´s Degree in Strategic Management and Control Management, PhD
in Human and Social Sciences, Professor at Rafael Núñez University Corporation - Surgical Instrument Technician Program. Cartagena,
Bolivar, Colombia.
e
Surgical Instrument Technician, Specialist in Epidemiology, Master´s Degree in Education, Rafael Núñez University Corporation. Cartagena,
Bolívar, Colombia.
f
Surgical Instrument Technician at Rafael Núñez University Corporation. Cartagena, Bolívar, Colombia.
Introduction: Scheduled surgery cancellation is a major problem in healthcare provision, negatively aecting patients
and their families, the healthcare sta, and the healthcare institution itself. It carries an increase in hospital costs, lost time,
and creates physical issues for healthcare sta. Methodology: A narrative review of the literature was carried out based on
concepts that specied the meaning of the search in the PubMed, Scielo, and Google academic databases. The inclusion
criteria were all articles, on the topic, published between 2014 and 2021, in Spanish and English, including an abstract, and
that could be accessed for free. Results: the main causes for surgery cancellation were identied and grouped as patient-
related factors, administrative aspects, logistics failures, such as lack of medical/surgical devices, and surgeon-related or
anesthesiologist-related causes. Conclusion: this topic will always be valid and a subject of continuous analysis, due to the
ARTICLE INFORMATION
Article Story:
Date received: september 28, 2022
Date accepted: june 21, 2023
Autor e-mail address:
Stephanye Carrillo:
stephanye.carrillo@curnvirtual.edu.co
DOI
10.31260/RepertMedCir.01217372.1392
Review article
ISSN: 0121-7372 • ISSN electrónico: 2462-991X
ABSTRACT
de Medicina y Cirugía
Vol.
33
N°1 . 2024
REPERT MED CIR. 2024;33(1):27-32
28
de Medicina y Cirugía
Palabras clave: cirugía, sala de cirugía, calidad, programación.
© 2024 Fundación Universitaria de Ciencias de la Salud - FUCS.
This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).
RESUMEN
INTRODUCTION
METHODOLOGY
Introducción: la cancelación de una cirugía es un tema relevante en la asistencia en salud, debido a las consecuencias en los
pacientes y su familia, el personal de salud y la institución. Está implícita el alza en los costos hospitalarios, el tiempo perdido
y las repercusiones físicas para el personal de salud. Metodología: revisión narrativa de la literatura sobre conceptos que
precisan el sentido de la búsqueda con herramientas en las bases de datos PubMed, Scielo y Google académico. Los criterios
de inclusión de los artículos fueron aquellos publicados desde 2014 hasta 2021 en español e inglés, que tuvieran resumen y
fueran accesibles sin algún tipo de pago. Resultados: las causas más frecuentes para cancelar las cirugías están enmarcadas
en factores propios del paciente, en la parte administrativa, en fallas de la logística como la ausencia de dispositivos médico-
quirúrgicos, y a la cancelación por el especialista y el anestesiólogo. Conclusión: esta temática siempre estará vigente y
en continuo análisis debido a las repercusiones en los pacientes, la institución, los costos y el personal del quirófano. Es
importante revisar las causas de la cancelación de cirugías, que al ser detectadas puedan solucionarse y contribuyan a la
mejora de la calidad de atención en la salud.
repercussions on patients, the institution, costs, and the operating room sta. To review the causes for surgery cancellation,
is important, so they may be addressed when detected, and may contribute to improve the quality of healthcare.
Keywords: microbiota, interacciones microbiota-hesped, síndrome metabólico, dieta, disbiosis.
© 2024 Fundación Universitaria de Ciencias de la Salud - FUCS.
Este es un artículo Open Access bajo la licencia CC BY-NC-ND (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Scheduled surgery cancellation implies the fact of not
performing a surgical procedure on the day and time it
was scheduled; or last-minute cancellations, even when
the patient is already in the operating room, resulting
in emotional distress for patients, related to postponing
their treatment, and is a parameter to assess the quality of
patient care from surgery planning to patient preparation.
Therefore, it is an adverse event, which unintentionally
generates hardships for the patient.
1
Surgery cancellation, “is dened as any scheduled
surgical intervention, which due to various reasons, cannot
be performed on the day and time in which it was scheduled,
nor be rescheduled “.
2
Given the growing incidence of trauma, cancer and
cardiovascular diseases, the burden of surgery on health
care systems will increase. It is estimated that 234 million
major surgeries are performed worldwide every year, which
is equivalent to one operation in every 25 people of the
overall world population. Despite the cost eectiveness
that surgery can have in terms of lives saved and disabilities
prevented, lack of access to quality surgical care remains a
serious problem worldwide.
1
The scheduled surgery cancellation rate reported in Latin
America varies between countries, for example, in Mexico
it ranges from 4.5% to 18% and in Colombia it represents
A narrative review of the literature was carried out based
on concepts that specify the meaning of the search in the
PubMed, Scielo, and Google academic databases. The key
DeCS descriptors used were operating room, quality, and
programming.
around 13.2%.
3
Cancellation rates in the rest of Latin
America have a similar behavior, 7.6% in Argentina, and
27.4% in Brazil (3.18). In other countries of the world,
elective surgery cancellation rates are 1.96-16.5% in the
United States; 21% in Pakistan; 30.3% in India; 4% in the
United Kingdom; 6.5% in Spain; 7.6% in Hong Kong; 4.5%
in Finland; and 0.37% in Taiwan.
4
In Colombia the rate of cancellation ranges between 2.7
and 7.6%
4
but has decreased from 6.95% in 2009 to 6.13% in
the last decade. Likewise, 70% of the authorized Healthcare
Providing Institutions (IPSs), reported a decreasing trend
of this indicator. Some studies have evidenced that a high
proportion of scheduled surgeries are canceled due to
potentially preventable reasons, most of the time.
5
It is worth noting that surgery cancellation is a signicant
event, which requires the attention of the healthcare team,
since institutions should be aware of the consequences that
may aect the patient, the family, the institution, and the
state itself, which generate additional costs, lost time, and
an increase in hospital admissions.
6
29
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DISCUSSION
The inclusion criteria were all original articles, review
articles, graduation research projects, and reports on the
topic, published between 2014 to 2021, in Spanish and
English.
The cancellation of surgeries is a crucial patient care
quality indicator. The goal is to minimize the frequency
of these events, especially when the reasons are not
patient-related but are due to failures in the sterilization
center processes, lack of surgical supplies, or institutional
disciplinary and administrative ineectiveness.
7
The most frequent reasons identied among studies were
similar, the most common being non- favorable clinical
conditions of patients to undergo surgery, institutional-
related issues regarding its structure and organization, and
patient absence.
8
The causes of surgery cancellation can be grouped into
three large categories:
A) Hospital-related causes, such as: overrun of previous
surgeries because of prolongation of procedures because of
unpredictable events, prolonged changeover and cleaning
time between surgeries due to infrastructure failures,
unavailability of a recovery bed, among others, lack of
surgical material: prostheses, electrosurgical cautery,
sutures, prosthetic mesh, etc., shortage of hospital beds,
nursing sta absences, surgical instrument technician failure
to ensure the correct surgical instruments are available, lack
of a blood bank in the institution, cancellation of the elective
surgery shift due to priority emergency surgeries, lack of a
bed in the Intensive Care Unit (UCI), and administrative
issues.
B) Patient-related causes: improvement in patient medical
status, acute intercurrent illness, patient rejects the surgeon,
cancellation by the patient, patient unpreparedness for
surgery for not following instructions correctly (patient
comes without fasting or did not stop anticoagulation
therapy, etc.), patient acute illness in days prior to surgery,
or patient no-shows on the day of surgery.
C) Medical sta-related causes: absence of the specialist,
cancellation by the surgeon or the anesthesiologist, not
requesting a preoperative evaluation or laboratory workup,
nonavailability of laboratory reports, and not conducting
preoperative blood ordering, when required.
2
In a hospital in Argentina, the overall surgery cancellation
rate was 7.6%. Logistics and administrative issues
represented 44.2%, while medical reasons (non-surgical)
reasons represented 40.8%. Anesthesia-related causes
accounted for 5.4% of overall surgery cancellations.
9
In Chile, a study conducted in 2018, found that in at least
57% of cases, the main cause of cancellation identied was
a change in patient medical status.
10
A study conducted by the National University of
Nicaragua in 2016, revealed that the most frequent causes
of surgery cancellation were:
1. Attributable to the patient: for failing to attend the
booked surgery appointment or presenting a hypertensive
crisis. 2. Attributable to the hospital: due to poor air
conditioning or lack of osteosynthesis materials. 3.
Attributable to human resources,
and nally, to the lack of a surgical instrument technician
or lack of a surgeon.
11
A study conducted in Cuba, found that most surgeries
were suspended for patient-related causes (89.8%), such as
patient nonattendance on the day of the intervention being
the most frequent (78.7%), or patient presenting high
blood pressure (3.8%). Other identied causes were a delay
of the previous surgical shift (3.6%) and administrative
issues (3.0%).
12
In Peru, a study detected the main factor for gynecological
surgeries cancellation were medical issues in 46.5%;
administrative issues in 36.6%, mainly due to lack of
operating room time in 25.4%.
13
Likewise, another study
conducted in Peru in 2016 showed that the causes of
suspension of surgeries according to patient institutional
status, are patient-related causes.
14
A study carried out in Cali, Colombia, found that 70.91%
of surgery cancellations in a level III clinic were attributed
to patient-related causes, 12.73% to administrative causes,
12.73% to causes related to the pandemic and 3.64% due
to causes related to the specialist. The specialties with the
highest rate of suspension were orthopedics and general
surgery.
15
Similarly, in Barranquilla, two studies were carried out
on this topic. Where in 2016, of the total 3207 scheduled
procedures, 7.6% were cancelled. The months with the
lowest and highest incidence of cancellation were August
with 3.7% and November with 14.8%, respectively. The
causes of cancellation were classied as attributable to the
institution (38.1%), the user (40.6%) and attributable to
medical orders (21.3%).
16
Diaz´s weekly study, found that the factor related to non-
favorable medical conditions aecting the patient, appeared
in up to 45.9% of cases.
17
A study conducted in the city of Bucaramanga in 2019,
reported that there were other causes of surgery cancellation
that may be attributable to administrative factors such as:
previous surgery prolongation in 16.5%, poor patient
preparation in 4.1%, unavailability of ICU bed in 16.3%,
unavailability of sterile clothing in 0.5%, unavailability
of surgical instruments in 0.2%, and unavailability of
medicines in 1.0%.
7
The cancellation of scheduled surgeries is considered as
one of the unsafe healthcare practices that can lead to adverse
events, specically including those factors related to resource
management, such as lack of surgical supplies or equipment,
lack of sterile clothing or sta shortage, as priority emergency
surgical procedures, superseding the elective schedule, may
also be povided (as shown in gure 1).
16
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CONCLUSION
Figure 1. Causes of cancellation of surgeries
Source: the authors.
Figure 2. Strategies to prevent the cancellation of surgeries.
Source: the authors.
The cancellation of elective surgeries is a frequent
phenomenon occurring in health institutions.
18
At the
national and international level, just three months after
the quarantine began in the world, due to the COVID-19
pandemic, more than 28.500.000 surgical interventions
were canceled in more than 190 countries around the
world. According to the WHO report, 30% of the aected
population were cancer patients.
19
The scientic research
group estimated that 72.3% of elective surgeries worldwide,
would be canceled during the COVID-19 pandemic.
20
As experienced at a Hospital in Madrid, Spain, the spread
of the SARS-CoV-2 (COVID-19) infection has required the
adaptation of hospitals aected by the pandemic, causing
an elective surgical activity reduction.
21
Most of the
surgical team personnel (93%) agreed with the cancellation
of elective procedures, and were willing to be relocated in
other services, if necessary.
22
It has been shown, that with the optimal use of COVID-19
infection prevention procedures, it is safe to intervene in
non-Covid-19 patients, since the surgical procedure do not
increase the risk of complications or the risk of contagion
for patients or health care professionals.
23
Various authors have provided recommendations to
reduce surgery cancellation rates, due to preventable
causes, such as, strengthening mandatory and adequate
application of the Double Pre-surgical Checklist. A study
conducted in Argentina, suggests healthcare professionals
to provide integrated verbal and written presurgical
instructions, which will perhaps contribute to timely
scheduled operations thus preventing their cancellation.
27
To promote patient surgical safety, the World Health
Organization developed the Surgical Safety Checklist.
Compliance with protocols such as a checklist guarantees
patient safety and accredits healthcare professionals´ good
practice.
28
It seeks to eliminate the factors that lead to the
cancellation of scheduled surgeries, through healthcare
teams and administrative sta self-assessment, on specic
aspects related to the prior planning of surgical procedures
regarding human resources, materials, and supplies
management.
29
The strategy for elective surgical procedures reactivation,
contemplates the expansion and adaptation of hospital
infrastructure, prioritizing intensive care units (ICU) and
reducing hospital admissions for surgical procedures (as
shown in gure 2).
30
Surgery cancellations occur most of the time on the
day of the scheduled procedure, generating an up to
90-minute delay in operating room changeover, increasing
cost overruns which are preventable by reviewing the
preoperative assessment processes.
24
The major causes for surgery cancellation were identied
and classied as patient-related factors, administrative
aspects, logistics failures, such as lack of surgical/ medical
Cancellation of surgeries amid the pandemic
Strategies to reduce surgery cancellation rates
Consequences of surgery cancellation
Patient-related
Hospital
environment
(logistics)
Administrative
Medical
specialist
Anesthesia
The cancellation of scheduled surgical procedures carries
social, economic and health impacts on the aected patients,
as well as on the whole population, by generating a decrease
of health care eectiveness and eciency.
25
The cancellation of a scheduled surgery is a crucial
quality measurement which can be related to ineciency in
the patient safety processes.
26
Communication: healthcare
staff - patient; patient -
surgical team members
Pre surgical checklist
(medical-surgical materials
and supplies)
Self-assessment,
including surgery
organization and planning
Pre-surgical instructions
to patients (both verbal
and written)
31
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supplies and devices, and cancellations dependent on
the specialist and anesthesiologist. Most of these causes
can be prevented by using tools such as providing clear
preoperative instructions to patients, and the application
of checklists through which the surgical sta reviews the
availability of the required supplies and equipment.
CONFLICT OF INTERESTS
The authors declare no conicts of interest and respect
the authorship of all consulted research publications.
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