Ferreira Joaquim, Boto Paulo
Serviço de Anestesiologia. Centro Hospitalar da Póvoa de Varzim/Vila do Conde. Póvoa de Varzim. Portugal.
Departamento de Gestão de Organizações e Serviços de Saúde. Escola Nacional de Saúde Pública. Lisboa. Portugal.
Acta Med Port. 2021 Feb 1;34(2):103-110. doi: 10.20344/amp.13437.
Cancellations of elective operations on the day of the surgery reflect the efficiency and quality within organisations, and have a significant clinical, social and economic impact, not only for the patient and their families, but also for healthcare institutions. This study assesses the extent of these cancellations in one public Portuguese hospital, through case quantification and identification of the causes, origin, as well as its predictability according to the sociodemographic variables of the patient and interventions used to decrease it.
Non-experimental descriptive quantitative methodology - longitudinal and retrospective - of operation cancellation cases on the day of the surgery, from the 1st of January to the 31st of December 2018.
The rate of cancellations of elective surgeries on the same day of the operation was 2.9% with variations among different surgical specialties; cancelled operations are more frequent in female patients, in patients aged between 50 and 80 years old, physical status classified as II or III according to the American Society of Anesthesiology, and without anaesthetic pre assessment or preoperative consultations; the three most relevant causes for cancellations are: lack of operative time, scarcity of beds and/or medical equipment, and changes in health status; most of which can be avoided and are the responsibility of the institution.
Different reasons for cancellation of elective operations reflect a variety of upstream and downstream processes causing cancellation of surgeries and whose origin/imputability is related to both the institution and patients.
The rate of cancellations of elective surgeries on the same day of the operation is relatively low, but the causes are often preventable, thus justifying the generalization of cancellation reduction strategies.
手术当天择期手术的取消反映了医疗机构内部的效率和质量，并且具有重大的临床、社会和经济影响，不仅对患者及其家属如此，对医疗机构也是如此。本研究通过病例量化、原因识别、起源分析以及根据患者的社会人口统计学变量和用于减少取消情况的干预措施评估其可预测性，来评估葡萄牙一家公立医院中这些取消情况的程度。
采用非实验性描述性定量方法——纵向和回顾性——对2018年1月1日至12月31日手术当天的手术取消病例进行研究。
手术当天择期手术的取消率为2.9%，不同外科专科之间存在差异；女性患者、年龄在50至80岁之间、根据美国麻醉医师协会身体状况分类为II或III级且未进行麻醉前评估或术前会诊的患者中取消手术更为常见；取消手术的三个最主要原因是：手术时间不足、床位和/或医疗设备短缺以及健康状况变化；其中大多数是可以避免的，且是医疗机构的责任。
择期手术取消的不同原因反映了导致手术取消的各种上游和下游流程，其起源/责任归属与医疗机构和患者都有关。
手术当天择期手术的取消率相对较低，但原因往往是可以预防的，因此有理由推广减少取消情况的策略。
