Surgery cancelation on the day of surgery in same-day admission in a Finnish hospital. 2013

J Laisi, and H Tohmo, and U Keränen
Department of Surgery, Hyvinkää Hospital, Hospital District of Helsinki and Uusimaa Sairaalankatu 1, Hyvinkää, Finland.

OBJECTIVE Surgery cancelations cause inappropriate use of hospital resources and additional financial and psychological stress to patients. Cancelation rates have been described to be even more than 10% of scheduled cases. Preoperative anesthesia evaluation clinics have been initialized to decrease cancelation rates. At Hyvinkää hospital, 95% of elective surgical patients are admitted on the morning of operation, and only 25% of these patients visit preoperative anesthesia evaluation clinic prior to surgery. Cancelation rate in Finnish hospitals has not been described. METHODS We studied retrospectively 12,205 scheduled elective same-day admission surgical cases at Helsinki and Uusimaa Hospital District, Hyvinkää hospital for a period of 2 years. Obstetric cases, emergency cases, and a few inpatient cases were excluded. A case was considered as canceled if surgery was canceled after the finalization of operation room schedule for the next day. Cancelation rates among different specialties and reasons for cancelation were analyzed. RESULTS A total of 12,205 surgeries were scheduled during the study period, and 551 (4.5%) of these were canceled. The highest cancelation rate was in hand surgery, with 8.2% of scheduled cases, followed by orthopedic surgery with 5.4%, and pediatric surgery with 5.1% cancelation rate. Endocrinology had no cancelations, and breast, urology, and vein surgery also had less than 2% of canceled cases. Patient-related issues caused 72.4% of cancelations, and operation no longer being necessary caused 26% of all cancelations. CONCLUSIONS Day of surgery cancelation rate was low in same-day admission, although it varied between specialties. Specialties having explicit surgery indications had fewer cancelations than specialties having surgery indications based on more subjective diagnostic. Process improvements need to be considered continuously to further decrease cancelation rate.

UI MeSH Term Description Entries
D011300 Preoperative Care Care given during the period prior to undergoing surgery when psychological and physical preparations are made according to the special needs of the individual patient. This period spans the time between admission to the hospital to the time the surgery begins. (From Dictionary of Health Services Management, 2d ed) Care, Preoperative,Preoperative Procedure,Preoperative Procedures,Procedure, Preoperative,Procedures, Preoperative
D005387 Finland A country in northern Europe, bordering the Baltic Sea, Gulf of Bothnia, and Gulf of Finland, between Sweden and Russia. The capital is Helsinki. Aland Islands,Åland Islands
D006760 Hospitalization The confinement of a patient in a hospital. Hospitalizations
D006767 Hospitals, District Government-controlled hospitals which represent the major health facility for a designated geographic area. District Hospitals,District Hospital,Hospital, District
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001071 Appointments and Schedules The different methods of scheduling patient visits, appointment systems, individual or group appointments, waiting times, waiting lists for hospitals, walk-in clinics, etc. Patient Appointments,Patient Schedules,Schedules, Patient,Appointments,Schedules,Appointment,Appointment, Patient,Appointments, Patient,Patient Appointment,Patient Schedule,Schedule,Schedule, Patient,Schedules and Appointments
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D013043 Specialties, Surgical Various branches of surgical practice limited to specialized areas. Surgical Specialties
D017064 Process Assessment, Health Care An evaluation procedure that focuses on how care is delivered, based on the premise that there are standards of performance for activities undertaken in delivering patient care, in which the specific actions taken, events occurring, and human interactions are compared with accepted standards. Process Assessment (Health Care),Assessment, Process,Process Measures,Assessment, Process (Health Care),Assessments, Process,Assessments, Process (Health Care),Measure, Process,Measures, Process,Process Assessment,Process Assessments,Process Assessments (Health Care),Process Measure
D017558 Elective Surgical Procedures Surgery which could be postponed or not done at all without danger to the patient. Elective surgery includes procedures to correct non-life-threatening medical problems as well as to alleviate conditions causing psychological stress or other potential risk to patients, e.g., cosmetic or contraceptive surgery. Surgical Procedures, Elective,Elective Surgical Procedure,Procedure, Elective Surgical,Procedures, Elective Surgical,Surgical Procedure, Elective

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