From the Faculty of Medicine, McGill University, Montréal, Que. (Denis); and the Division of Orthopaedic Surgery, McGill University, Montréal, Que. (Montreuil, Harvey, Berry, Reindl, Bernstein)
From the Faculty of Medicine, McGill University, Montréal, Que. (Denis); and the Division of Orthopaedic Surgery, McGill University, Montréal, Que. (Montreuil, Harvey, Berry, Reindl, Bernstein).
Can J Surg. 2022 Jun 14;65(3):E382-E387. doi: 10.1503/cjs.009420. Print 2022 May-Jun.
Day-of surgery cancellation (DOSC) is considered to be a very inefficient use of hospital resources and results in emotional stress for the patient. To examine opportunities to minimize the incidence of preventable cancellations - an indicator of quality of care - we assessed the incidence of and reasons for DOSCs over 3 months among inpatients and outpatients at a trauma orthopedic service.
This was a prospective study of 2 cohorts of patients, inpatients and outpatients, scheduled for emergent orthopedic surgery at a Canadian tertiary level 1 trauma centre from Jan. 1 to Mar. 31, 2020. Patient demographic characteristics, injury characteristics, delays until surgery and reasons for DOSCs were recorded.
A total of 185 patients (100 males and 85 females with a mean age of 54 yr) were included in the study. There were 98 outpatients and 87 inpatients. Seventy-five (40%) of the scheduled procedures in the outpatient group and 34 (30%) of those in the inpatient group were cancelled. In both groups, more than 85% of the cancellations were because of prioritization of a more urgent orthopedic or nonorthopedic surgical case. The average operative delay for the outpatient group was 11.4 days, compared to 3.8 days for the inpatient group ( < 0.001).
High DOSC rates were observed among both outpatients and inpatients. The main reason for delaying surgery was prioritization of a more urgent surgical case. Providing the orthopedic trauma service with a dedicated OR opened 6 days per week, along with extended hours of OR services to 1700 daily, might be effective at minimizing DOSCs.
手术当日取消（DOSC）被认为是对医院资源的极不高效利用，并且会给患者带来情绪压力。为了研究减少可预防取消的机会（这是护理质量的一个指标），我们评估了在创伤骨科服务中，3 个月内在门诊和住院患者中发生不可避免取消的发生率和原因。
这是一项对 2020 年 1 月 1 日至 3 月 31 日期间在加拿大 1 级创伤中心接受紧急骨科手术的门诊和住院患者的前瞻性研究。记录患者的人口统计学特征、损伤特征、手术延迟时间和 DOSC 的原因。
共有 185 名患者（100 名男性和 85 名女性，平均年龄为 54 岁）纳入研究。其中有 98 名门诊患者和 87 名住院患者。门诊组计划的 75 例（40%）手术和住院组的 34 例（30%）手术被取消。在两组中，超过 85%的取消是因为优先考虑更紧急的骨科或非骨科手术病例。门诊组的平均手术延迟时间为 11.4 天，而住院组为 3.8 天（<0.001）。
门诊和住院患者的 DOSC 发生率均较高。延迟手术的主要原因是优先考虑更紧急的手术病例。每周提供 6 天专门的手术室和每天延长 1700 小时的手术室服务，可能有助于最大限度地减少 DOSC。
