Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minn.
Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minn; Center for the Science of Health Care Delivery, Mayo Clinic College of Medicine, Rochester, Minn.
J Thorac Cardiovasc Surg. 2014 Aug;148(2):721-5. doi: 10.1016/j.jtcvs.2014.03.002. Epub 2014 Mar 5.
Same-day cancellations of cardiac surgery are unfortunate and costly occurrences that potentially place patients at risk of adverse events.
We retrospectively reviewed all same-day cancellations of cardiac operations requiring cardiopulmonary bypass from 2010 to 2012 at a large academic tertiary referral center.
Of 7081 cardiac operations, 134 patients experienced 142 same-day cancellations of cardiac surgery. The foreseeable cancellation causes comprised 17% of cancellations, nonforeseeable 59%, and indeterminate 24%. The reasons for cancellation were medical (51%), administrative or scheduling (17%), unknown (12%), procedure no longer required (11%), patient cancellation (6%), and preincisional complication (3%). The mean interval from the patient seeing a nonsurgeon provider to cancellation was 8.6 ± 16.2 days. No statistically significant differences existed between the foreseeable and nonforeseeable cancellations and the timing of the visit to a nonsurgeon provider (15, 30, 45, and 60 days) before cancellation. Seven patients (5%) had died within 30 days of cancellation. Of those subsequently operated on, the mean interval from cancellation to performance of the operation was 12.2 ± 22.7 days. Of the 142 cancelled surgical procedures, 28 (20%) were never subsequently performed.
Same-day cancellation of cardiac surgery occurred infrequently (2% of cardiac operations performed) at our institution. The cancellations were for foreseeable causes in a few cases. Seeing a nonsurgeon provider more recently before cancellation was not significantly associated with nonforeseeable versus foreseeable cancellations. Although uncommon at our institution, same-day cancellations should be viewed as an opportunity for practice improvement, given the foreseeable nature of some cancelations, associated 30-day mortality, and portion of patients not subsequently undergoing cardiac surgery.
心脏手术当天取消是不幸且代价高昂的事件，可能使患者面临不良事件的风险。
我们回顾性分析了 2010 年至 2012 年在一家大型学术三级转诊中心进行的所有需要体外循环的心脏手术当天取消的病例。
在 7081 例心脏手术中，134 例患者经历了 142 例心脏手术当天取消。可预见的取消原因占取消原因的 17%，不可预见的占 59%，不确定的占 24%。取消的原因是医疗（51%）、行政或安排（17%）、未知（12%）、不再需要手术（11%）、患者取消（6%）和术前并发症（3%）。从患者看非外科医生到取消的平均间隔时间为 8.6±16.2 天。可预见和不可预见的取消之间以及在取消前看非外科医生的时间（15、30、45 和 60 天）没有统计学差异。7 例患者（5%）在取消后 30 天内死亡。在随后接受手术的患者中，从取消到手术的平均间隔时间为 12.2±22.7 天。在取消的 142 例手术中，28 例（20%）从未再次进行。
我们机构心脏手术当天取消的情况很少见（占心脏手术的 2%）。在少数情况下，取消是由于可预见的原因。在取消前最近看非外科医生与可预见和不可预见的取消之间没有显著相关性。尽管在我们机构很少见，但鉴于一些取消是可预见的，以及与 30 天死亡率相关的，以及部分患者未随后接受心脏手术，当天取消应被视为改进实践的机会。
