Sultan Nabeel, Rashid Abdul, Abbas Syed M
Leicester Royal Infirmary, Leicester UK; Saudi Arabia.
J Saudi Heart Assoc. 2012 Jan;24(1):29-34. doi: 10.1016/j.jsha.2011.10.006. Epub 2011 Oct 24.
The cancellation of surgery is a significant drain on health resources. However, a persistent problem in most hospitals is short notice cancellation of scheduled operations, even upto the day of surgery. In some cases, patients have been prepared for surgery, and the staff is assembled and expecting to operate. In UK 8% of scheduled elective operations are cancelled within 24 hours of surgery. The reasons include cancellation by the patient, cancellation for poorly optimized medical conditions, or cancellations due to poor organization. Many of these are difficult to quantify. However, one relatively easily measured factor is the possibility that some operating lists were predictably over-booked. An operating list may over-run because of delayed starts, slow turnover, unanticipated surgical/anaesthetic problems or staff shortages. Many of these are difficult to quantify.
Prince Sultan Cardiac center is one of the largest referral center in the Middle East and there is no published data on the reasons for cancellation of specifically cardiac procedures. However, an audit was performed to assess the reasons for the cancellation of the cases on the day of surgery in cardiac theatres. According to one of the studies published in an Australian journal the percentage of cancelled cardiothoracic cases was determined to be 15.8%.
Total number of cardiac surgical patients including pediatric and adult during a period from June 2008 to May 2009 were 2191. Out of those, 1681 cases were done during the study period, 510 (23.27%) cases were cancelled during the study period. The operation theatre was functional for 331 days during the study period. Cancellations done by the surgeons were 34% while the patient's related cancellations were 32%. The administrative issues contributed to 34% in overall cancellation and anaesthetist-related cancellation were 0%.
We estimated 22% of the elective operations which were cancelled on the day of surgery were potentially avoidable. There is still a need to do further research to look for the identifiable reasons and strategic measures to eliminate the reasons for cancellation on the day of surgery.
手术取消对卫生资源造成了重大消耗。然而，大多数医院一直存在的一个问题是，预定手术的临时取消，甚至直到手术当天才取消。在某些情况下，患者已为手术做好准备，工作人员也已集合并准备进行手术。在英国，8%的预定择期手术在手术前24小时内被取消。原因包括患者取消、因医疗状况未得到充分优化而取消，或因组织不善而取消。其中许多原因难以量化。然而，一个相对容易衡量的因素是某些手术安排表可能被过度预订。手术安排表可能会超时，原因包括开始延迟、周转缓慢、意外的手术/麻醉问题或人员短缺。其中许多原因难以量化。
苏丹王子心脏中心是中东地区最大的转诊中心之一，目前尚无关于特定心脏手术取消原因的公开数据。然而，我们进行了一项审计，以评估心脏手术室手术当天病例取消的原因。根据澳大利亚一本期刊发表的一项研究，心胸外科手术取消的比例为15.8%。
2008年6月至2009年5月期间，包括儿科和成人在内的心脏外科患者总数为2191例。其中，1681例在研究期间完成手术，510例（23.27%）在研究期间被取消。研究期间手术室运行了331天。外科医生取消的手术占34%，与患者相关的取消手术占32%。行政问题导致的取消手术占总体取消手术的34%，与麻醉师相关的取消手术为0%。
我们估计，手术当天取消的择期手术中有22%可能是可以避免的。仍有必要进一步研究，以寻找可识别的原因以及消除手术当天取消手术原因的战略措施。
