I should like to comment on the article by González-Arévalo et al. . The authors found that the overall cancellation rate was 6.5%, of which approximately half (3%) was for medical reasons. I have recently conducted a two year audit of pre-assessment and cancellation rates at our hospital. I compared one year of anaesthetic-led pre-assessment clinic (2009/10) with the previous year’s nurse-led pre-assessment (2008/09). I pre-assessed general surgical, colorectal and orthopaedic inpatients in one single dedicated session per week. This represented more than 1250 case notes reviewed and about 35 face-to-face appointments. The total number of cancellations in our hospital for all reasons was 565 out of 3115 (18%) in 2008/09 and 726 out of 3356 in 2009/10 (21%). The majority of cancellations were due to theatre overrun or surgical factors. During 2008/09 the cancellation rate for medical or anaesthetic reasons was 5.4% as a proportion of all operations (30% of all cancellations). During 2009/10 this figure decreased to 3.8% (17% of all cancellations).
Some of the differences in our results can be explained by a different patient case-mix; González-Arévalo et al. studied all operations, including paediatric patients. These represented a substantial proportion of the total and included a high rate of upper repiratory tract infections. Our patients were adults undergoing general or orthopaedic surgery often with multiple co-morbidities requiring anaesthetic input.
González-Arévalo et al. explain the relatively high percentage of patient non-attendance (20% of cancellations, or 1% of operations). Their pre-assessment was scheduled 2 – 3 months before surgery, The authors argue the case for earlier pre-assessment on the grounds of better optimization. Our pre-assessments occurred about 4 weeks before surgery in both years. My audit showed that pre-assessment closer to the operation date did not affect the cancellation rate adversely.
In summary, anaesthetic pre-assessment less than 1 month before surgery significantly reduced cancellation rates due to inadequate pre-operative preparation. Our results compare favourably with other published studies from the U.K. [2,3,4]. However, overall cancellation rate is still too high. To improve theatre efficiency, operating list booking systems should take into consideration individual surgeons’ operating times.
William Harvey Hospital
East Kent Hospitals University Foundation Trust
Ashford, Kent, U.K.
E- mail: firstname.lastname@example.org
No competing interests and no external funding declared.
1. González-Arévalo et al. Causes for cancellation of elective surgical procedures in a Spanish general hospital. Anaesthesia 2009; 64: 487–93.
2. Barnes PK, Emerson PA, Hajnal S, Radford WJP, Congleton J. Influence of an anaesthetist on nurse led, computer-based, pre-operative assessment. Anaesthesia 2000; 55: 576 – 580
3. Rai MR, Pandit JJ. Day of surgery cancellations after nurse-led pre-assessment in an elective surgical centre: the first 2 years. Anaesthesia 2003; 58: 692–699
4. Sanjay P, Dodds A, Miller E, Arumugam PJ, Woodward A. Cancelled elective operations: an observational study from a district general hospital. Journal of Health Organisation and Management 2007; 21: 54-8