Surgical Case Cancellations at a Safety Net Hospital: Implications for Patient Care and Resource Management.

Introduction: Surgical cancellations disrupt hospital operations, reduce efficiency, and delay patient care. These cancellations occur for a variety of reasons including hospital-related issues, patient-related challenges, inadequate preoperative workup, or logistical barriers. Although some factors have been well-studied, a complete understanding of cancellations at safety net hospitals, which serve a unique and vulnerable population, is yet to be elucidated.

Methods: This is a single institution retrospective study. The electronic health system was queried for patients from 2022 to 2024 who were scheduled for surgery. Details of the cancellation date and reason, urgency of case, surgical service, and location of surgery were captured. Specific reason of cancellation was then divided into broad categories: scheduling, change in treatment, patient, medical professional, facility, and social.

Results: There were a total of 34,441 cases scheduled and 5939 canceled procedures. The overall surgical cancellation rate was 17.2%. Cancellations were more frequent in the main operating room (19%) compared to the ambulatory operating room (13%). 86.3% of cases were canceled the same day of surgery. The reasons for cancellation were as follows: scheduling 37.3%, patient-related 35.0%, social 12.6%, change in treatment 8.2%, facility-related 3.6%, and medical professional-related 3.3%. When accounting for total volume in a specialty-specific analysis, pulmonary had the highest proportion of canceled cases, followed by gastroenterology, podiatry, and oral maxillofacial surgery.

Conclusion: There is a significant rate of surgical case cancellations, particularly same-day cancellations, in our study at a single institution tertiary care and safety net hospital, predominantly related to scheduling, patient-related, and social factors. Specific interventions and systems improvements are urgently needed to improve assessment of patient-related factors, fix problems with scheduling of cases, and support patients who lack access to care. The added resources for these process improvement interventions that will be required may be offset by the improved efficiency and lower cancellation rate.