Department of Surgery, Hyvinkää Hospital, Hospital District of Helsinki and Uusimaa Sairaalankatu 1, Hyvinkää, Finland.
Scand J Surg. 2013;102(3):204-8. doi: 10.1177/1457496913492626.
Surgery cancelations cause inappropriate use of hospital resources and additional financial and psychological stress to patients. Cancelation rates have been described to be even more than 10% of scheduled cases. Preoperative anesthesia evaluation clinics have been initialized to decrease cancelation rates. At Hyvinkää hospital, 95% of elective surgical patients are admitted on the morning of operation, and only 25% of these patients visit preoperative anesthesia evaluation clinic prior to surgery. Cancelation rate in Finnish hospitals has not been described.
We studied retrospectively 12,205 scheduled elective same-day admission surgical cases at Helsinki and Uusimaa Hospital District, Hyvinkää hospital for a period of 2 years. Obstetric cases, emergency cases, and a few inpatient cases were excluded. A case was considered as canceled if surgery was canceled after the finalization of operation room schedule for the next day. Cancelation rates among different specialties and reasons for cancelation were analyzed.
A total of 12,205 surgeries were scheduled during the study period, and 551 (4.5%) of these were canceled. The highest cancelation rate was in hand surgery, with 8.2% of scheduled cases, followed by orthopedic surgery with 5.4%, and pediatric surgery with 5.1% cancelation rate. Endocrinology had no cancelations, and breast, urology, and vein surgery also had less than 2% of canceled cases. Patient-related issues caused 72.4% of cancelations, and operation no longer being necessary caused 26% of all cancelations.
Day of surgery cancelation rate was low in same-day admission, although it varied between specialties. Specialties having explicit surgery indications had fewer cancelations than specialties having surgery indications based on more subjective diagnostic. Process improvements need to be considered continuously to further decrease cancelation rate.
手术取消会导致医院资源的不当使用，并给患者带来额外的经济和心理压力。据报道，手术取消率甚至超过了预定病例的 10%。术前麻醉评估诊所的设立旨在降低取消率。在海文卡亚医院，95%的择期手术患者在手术当天上午入院，只有 25%的患者在手术前会去术前麻醉评估诊所。芬兰医院的取消率尚未有报道。
我们对 2 年内赫尔辛基和乌西玛地区海文卡亚医院的 12205 例计划进行的择期当日入院手术进行了回顾性研究。排除产科病例、急诊病例和少数住院病例。如果手术在第二天手术室日程安排确定后被取消，则视为取消。分析了不同科室的取消率和取消原因。
研究期间共安排了 12205 例手术，其中 551 例（4.5%）被取消。手外科的取消率最高，为 8.2%，其次是骨科，为 5.4%，儿科为 5.1%。内分泌科没有取消手术，乳腺、泌尿科和静脉外科的取消手术也不到 2%。患者相关问题导致 72.4%的取消，而不再需要手术则导致 26%的取消。
虽然各科室之间存在差异，但当日入院手术的取消率较低。具有明确手术适应证的科室比基于更主观诊断的手术适应证的科室取消率要低。需要不断考虑进行流程改进，以进一步降低取消率。
