Leslie Robert J, Beiko Darren, van Vlymen Janet, Siemens D Robert
Departments of Urology, Queen's University, Kingston, ON;
Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON;
Can Urol Assoc J. 2013 May-Jun;7(5-6):167-73. doi: 10.5489/cuaj.12020.
Day-of-surgery cancellations have a negative effect on operating room (OR) resources, as well as on patient satisfaction and perception of quality of care. Given increasing wait times in a universal healthcare system and the nature of urological surgery in our aging population, it should be a priority to identify modifiable risks of OR cancellations to assure timely and efficient delivery of care. We explore the rate and reasons for elective surgery cancellations in a Canadian urological practice.
We evaluated the rate and reason of urological surgery cancellation at a single academic institution, prospectively collected in our centre's Operating Room Scheduling Office System (ORSOS) database. Documented reasons for cancellations were divided into 3 components: (1) structural factors (e.g., no hospital bed); (2) patient factors (e.g., patient unwell); and (3) process factors (e.g., scheduling error). Rates and reasons for cancellations were compared to those of General Surgery and Gynecology. The documented reasons for cancellation in the ORSOS database were confirmed or extended by chart review and interviews with a subset of cancelled patients.
Between 2005 and 2009, 1544 out of 19 141 (8.07 %) elective surgical cases were cancelled within the three surgical specialties (general surgery, gynecology and urology); urology had the highest average rate of 9.53%. Non-oncological cases represented a higher percentage of cancelled cases (15%, p < 0.001) and overall rates varied significantly over time in urology compared to the other surgical specialties. Potentially modifiable, process-related causes were by far the most common reason for cancellation (58.5%) and "standby" cases were a common cause of overall cancellation rates. Patient interviews confirmed the emotional and financial impact of cancellation; there was no overwhelming concern that clinical outcomes were negatively affected.
This contemporary exploration of cancelled urological cases is consistent with previous reports, although variable over time and dependent on definitions used. Potentially modifiable, process-related factors appear to be most frequently associated with cancellation, although more thorough and detailed documentation is required to further mitigate inefficient OR use. We suggest that all OR cancellations should be considered to be adverse incidents to be monitored by institutions in a systematic fashion.
手术当日取消手术对手术室（OR）资源以及患者满意度和医疗质量感知均有负面影响。鉴于全民医疗体系中等待时间不断增加以及我国老年人口泌尿外科手术的性质，确定可改变的手术取消风险应成为优先事项，以确保及时、高效地提供医疗服务。我们探讨了加拿大一家泌尿外科诊所择期手术取消的发生率及原因。
我们评估了一家学术机构泌尿外科手术取消的发生率及原因，这些数据前瞻性地收集于我们中心的手术室调度办公室系统（ORSOS）数据库。记录的取消原因分为三个部分：（1）结构因素（如无医院床位）；（2）患者因素（如患者身体不适）；（3）流程因素（如调度错误）。将取消手术的发生率及原因与普通外科和妇科进行比较。通过病历审查以及对部分取消手术患者的访谈，对ORSOS数据库中记录的取消原因进行确认或补充。
2005年至2009年期间，19141例择期手术病例中有1544例（8.07%）在三个外科专科（普通外科、妇科和泌尿外科）中被取消；泌尿外科的平均取消率最高，为9.53%。非肿瘤病例占取消病例的比例更高（15%，p<0.001），与其他外科专科相比，泌尿外科的总体取消率随时间变化显著。潜在可改变的、与流程相关的原因是迄今为止最常见的取消原因（58.5%），“备用”病例是总体取消率的常见原因。患者访谈证实了取消手术对患者情绪和经济的影响；患者并未普遍担心临床结果会受到负面影响。
此次对取消的泌尿外科病例的当代研究与先前报告一致，尽管随时间变化且取决于所使用的定义。潜在可改变的、与流程相关的因素似乎最常与手术取消相关，不过需要更全面、详细的记录以进一步减少手术室使用效率低下的情况。我们建议所有手术室手术取消都应被视为不良事件，由各机构进行系统监测。
