INTRODUCTION: Surgical cancellations affect hospital efficiency and impact patient outcomes. Understanding patient and systems factors that contribute to case cancellation is essential to optimizing patient care. OBJECTIVE: The purpose of this study was to examine the prevalence of surgical cancellations and identify risk factors associated with surgical cancellation at a tertiary care safety net hospital. We hypothesized that socioeconomic factors, medical comorbidities, and age would increase the risk of surgical case cancellation. METHODS: This was a case–control study including OBGYN patients undergoing scheduled gynecologic surgery between December 2023 and May 2024. Retrospective chart review was performed with an existing clinic quality improvement database. Patient demographics and relevant clinical and surgical factors were abstracted from the medical record. Patients who experienced surgical cancellation were labeled “cases,” while those who completed their scheduled surgery were labeled “controls.” Summary statistics are presented as n (%) or median (range). Bivariate analysis was performed to identify significant differences (p < 0.05). Multivariable logistic regression was performed to identify factors associated with increased likelihood of cancellation. RESULTS: 282 patients were included in the analysis. 67 (23.8%) experienced cancellation of their initial surgery. The most commonly cancelled case subspecialty was complex family planning (34.5%), followed by gynecologic oncology (27.5%) and female pelvic medicine and reconstructive surgery (10.3%). 23/67 cases were cancelled due to patient comorbidities (35.9%), and 20/67 (31.3%) were cancelled due to patient preference. The median time of cancellation was 3 (0–12) days prior to scheduled surgery. Out of 67 cancellations, 38 patients (56.72%) ultimately underwent their planned surgical procedure. The median time to completion of the rescheduled surgery was 40 (21–63) days. Only 2/67 (3%) patients experienced a hospital admission or emergency room visit after cancellation. In a bivariate analysis, demographic factors were not significant predictors of surgical cancellations. Patients who experienced surgical cancellation were less likely to have completed pre-admission testing (78.1% vs 13.3%, p < 0.0001). Plan for a laparoscopic bilateral salpingectomy was associated with a greater risk of cancellation (29.7% vs 18.4%, p = 0.05) while plan for vaginal hysterectomy was associated with lower risk (4.48% vs 14.88%, p = 0.01). In a multivariate logistic regression analysis including demographic factors and indication for surgery, desire for permanent sterilization was associated with increased odds of surgical case cancellation (OR 2.72 1.24–5.98, p = 0.01). CONCLUSIONS: Surgical case cancellation represents a suboptimal outcome for both patients and providers. We found that up to 23.8% of scheduled gynecologic cases at our hospital are cancelled. Patient preferences and comorbidities were the most common reasons for cancellation. Despite undertaking this analysis at a safety-net hospital, this study did not find any social factors predictive of surgical cancellation. Consistent with prior data, a planned sterilization procedure carried the highest risk of surgical cancellation. Future studies are planned to examine a larger dataset covering a wider date range, as well as examining cancellation rates and associated factors at other hospitals within our institution.
Simi et al. (Fri,) studied this question.