This study aimed to examine the factors associated with the cancellation of elective shoulder surgeries, focusing mainly on socioeconomic aspects, and to explore these associations stratified by rural and urban areas. A retrospective cross-sectional analysis was conducted using the electronic medical records of 1,001 adult patients scheduled for elective shoulder surgery under general anesthesia at a tertiary hospital in South Korea between April 2018 and December 2024. Surgery cancellation was defined as any procedure recorded as "canceled" before the scheduled surgery date. Sociodemographic, clinical, and surgery-related factors were analyzed using chi-squared tests and multivariate logistic regression models. Stratified analyses were also conducted based on residential area. The overall surgical cancellation rate was 11.5%. Older age (≥65 years), severe disease, rural residence, manual labor, and complex surgical procedures were significantly associated with higher odds of cancellation. The multivariate analysis showed that patients aged 65 years or older (adjusted OR = 2.20, p < 0.001), those with severe disease (adjusted OR = 4.29, p = 0.004), manual laborers (adjusted OR = 2.93, p < 0.001), and rural residents (adjusted OR = 1.87, p = 0.006) were at a greater risk of cancellation. Stratified analysis revealed that Medical Aid coverage significantly increased the risk of cancellation in rural areas (adjusted OR = 5.76, p = 0.025). Elective shoulder surgery cancellations are influenced not only by clinical factors but also by socioeconomic and geographical disparities. Patient-centered surgical planning that incorporates individual socioeconomic circumstances is essential for reducing cancellation rates and promoting equitable surgical care.