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Cancelled operations: a 7-day cohort study of planned adult inpatient surgery in 245 UK National Health Service hospitals

  • West Herts Hospitals NHS Trust
  • , Weston Area Health NHS Trust
  • , West Suffolk NHS Foundation Trust
  • , The Whittington Hospital NHS Trust
  • , Wirral University Teaching Hospital NHS Foundation Trust
  • , Worcestershire Acute Hospitals NHS Trust
  • , Wrightington, Wigan and Leigh NHS Foundation Trust
  • , Wye Valley NHS Trust
  • , Yeovil District Hospital NHS Foundation Trust
  • , York Teaching Hospital NHS Foundation Trust
  • , the SNAP-2: EPICCS collaborators
  • , Health Services Research Centre, National Institute of Academic Anaesthesia
  • , Study Steering Group
  • , Net Solving Limited
  • , Trainee Research Networks
  • , Abertawe Bro Morgannwg University Health Board
  • , Aintree University Hospitals NHS Foundation Trust
  • , Airedale NHS Foundation Trust
  • , Aneurin Bevan Health Board
  • , Ashford & St Peters NHS Foundation Trust
    • Barking, Havering and Redbridge University Hospitals NHS Trust, Barnsley Hospital NHS Foundation Trust, Barts Health NHS Trust, Basildon and Thurrock University Hospitals NHS Foundation Trust, Bedford Hospital NHS Trust, Belfast Health and Social Care Trust, Betsi Cadwaladr University Health Board, Birmingham Women's NHS Foundation Trust, Blackpool Teaching Hospitals NHS Foundation Trust, Bolton Hospital NHS Foundation Trust, Bradford Teaching Hospitals NHS Foundation Trust, Brighton and Sussex University Hospitals NHS Trust, Buckinghamshire Healthcare NHS Trust, Burton Hospitals NHS Foundation Trust, Calderdale and Huddersfield NHS Foundation Trust, Cambridge University Hospitals NHS Foundation Trust, Cardiff and Vale University Health Board, Central Manchester University Hospitals NHS Foundation Trust, Chelsea and Westminster Hospital NHS Foundation Trust, Chesterfield Royal Hospital NHS Foundation Trust, The Christie Hospital NHS Foundation Trust, City Hospitals Sunderland NHS Foundation Trust, Colchester Hospital University NHS Foundation Trust, Countess of Chester NHS Foundation Trust, County Durham and Darlington NHS Foundation Trust, Croydon Health Services NHS Trust, Cwm Taf University Health Board, Dartford and Gravesham NHS Trust, Derby Hospitals NHS Foundation Trust, Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Dorset County Hospital NHS Foundation Trust, The Dudley Group NHS Foundation Trust, East and North Hertfordshire NHS Trust, East Kent Hospitals University NHS Foundation Trust, East Lancashire Hospitals NHS Trust, East Sussex Healthcare NHS Trust, Epsom and St Helier University Hospitals NHS Trust, Frimley Health NHS Foundation Trust, Gateshead Health NHS Foundation Trust, Gloucestershire Hospitals NHS Foundation Trust, Great Western Hospitals NHS Foundation Trust, Guy's and St Thomas’ NHS Foundation Trust, Hampshire Hospitals NHS Foundation Trust, Harrogate and District NHS Foundation Trust, Heart Of England NHS Foundation Trust, The Hillingdon Hospitals NHS Foundation Trust, Homerton University Hospital NHS Foundation Trust, Hull and East Yorkshire Hospitals NHS Trust, Hywel Dda Health Board, Imperial College Healthcare NHS Trust, Ipswich Hospital NHS Trust, Isle of Wight NHS Trust, James Paget University Hospitals NHS Foundation Trust, Kettering General Hospital NHS Foundation Trust, King's College Hospital NHS Foundation Trust, Kingston Hospital NHS Foundation Trust, Lancashire Teaching Hospitals NHS Foundation Trust, Leeds Teaching Hospitals NHS Trust, Lewisham and Greenwich NHS Trust, Liverpool Women's NHS Foundation Trust, Luton and Dunstable University Hospital NHS Foundation Trust, Medway NHS Foundation Trust, Mid Cheshire Hospitals NHS Foundation Trust, Mid Essex Hospital Services NHS Trust, Mid Yorkshire Hospitals NHS Trust, Milton Keynes University Hospital NHS Foundation Trust, Newcastle upon Tyne Hospitals NHS Foundation Trust, NHS Ayrshire & Arran, NHS Dumfries & Galloway, NHS Fife, NHS Greater Glasgow & Clyde, NHS Highland, NHS Lanarkshire, NHS Lothian, NHS Scotland Special Board, NHS Shetland, NHS Tayside, Norfolk and Norwich University Hospitals NHS Foundation Trust, Northampton General Hospital NHS Trust, North Bristol NHS Trust, North Cumbria University Hospitals NHS Trust, Northern Devon Healthcare NHS Trust, Northern Health and Social Care Trust, Northern Lincolnshire and Goole Hospitals NHS Foundation Trust, North Middlesex University Hospital NHS Trust, North Tees and Hartlepool NHS Trust, Northumbria Healthcare NHS Foundation Trust, North West Anglia NHS Foundation Trust, Nottingham University Hospitals NHS Trust, Oxford University Hospitals NHS Foundation Trust, Papworth Hospital NHS Foundation Trust, Pennine Acute NHS Trust, Plymouth Hospitals NHS Trust, Poole Hospital NHS Foundation Trust, Portsmouth Hospitals NHS Trust, The Princess Alexandra Hospital NHS Trust, Queen Elizabeth Hospital NHS Foundation Trust, Queen Victoria Hospital NHS Foundation Trust, Robert Jones and Agnes Hunt Orthopaedic Hospital Foundation Trust, Rotherham NHS Foundation Trust, Royal Berkshire NHS Foundation Trust, Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust, Royal Cornwall Hospitals NHS Trust, Royal Devon and Exeter NHS Foundation Trust, Royal Free London NHS Foundation Trust, The Royal Liverpool and Broadgreen University Hospitals NHS Trust, The Royal Marsden NHS Foundation Trust, Royal National Orthopaedic Hospital NHS Trust, The Royal Orthopaedic Hospital NHS Foundation Trust, Royal Surrey County Hospital NHS Foundation Trust, Royal United Hospitals Bath NHS Trust, The Royal Wolverhampton Hospitals NHS Trust, Salford Royal NHS Foundation Trust, Salisbury NHS Foundation Trust, Sandwell and West Birmingham Hospitals NHS Trust, Sheffield Teaching Hospitals NHS Foundation Trust, Shrewsbury and Telford Hospital NHS Trust, South Eastern Health and Social Care Trust, Southport and Ormskirk Hospital NHS Trust, South Tees Hospitals NHS Foundation Trust, South Tyneside NHS Foundation Trust, South Warwickshire NHS Foundation Trust, St George's Healthcare NHS Trust, St Helens and Knowsley Teaching Hospitals NHS Trust, Stockport NHS Foundation Trust, Surrey and Sussex Healthcare NHS Trust, Tameside Hospital NHS Foundation Trust, Taunton and Somerset NHS Foundation Trust, Torbay and South Devon NHS Foundation Trust, United Lincolnshire Hospitals NHS Trust, University College London Hospitals NHS Foundation Trust, University Hospital of North Midlands NHS Trust, University Hospital of South Manchester NHS Foundation Trust, University Hospitals Birmingham NHS Foundation Trust, University Hospitals Bristol NHS Foundation Trust, University Hospitals Coventry and Warwickshire NHS Trust, University Hospitals of Leicester NHS Trust, University Hospitals of Morecambe Bay NHS Foundation Trust, University Hospital Southampton NHS Foundation Trust, Walsall Healthcare NHS Trust, Warrington & Halton Hospitals NHS Foundation Trust, Western Health and Social Care Trust, Western Sussex Hospitals NHS Foundation Trust, Danny J.N. Wong, S. K. Harris, S. R. Moonesinghe, Steve K. Harris, James Bedford, Oliver Boney, Maria Chazapis, Sharon Drake, Laura Farmer, David Gilhooly, James Goodwin, Jose Lourtie, Duncan Wagstaff, Mike Grocott, Robert Sneyd, Anna Batchelor, Stephen Brett, Catherine Plowright, Suman Shrestha, Richard Shawyer, Shafi Ahmed, Mizan Khondoker, Mike Nathanson, Paul Cripps, Shilpa Rawat, Sonia Sathe, Alison Campbell, Janakan Anandarajah, Nicola Ball, Lalindra Bandara, Dennis Barnes, Catherine Chapman, Emma Murphy

Research output: Contribution to journal › Article › peer-review

105   Link opens in a new tab Citations (Scopus)

Abstract

Background: Cancellation of planned surgery impacts substantially on patients and health systems. This study describes the incidence and reasons for cancellation of inpatient surgery in the UK NHS. Methods: We conducted a prospective observational cohort study over 7 consecutive days in March 2017 in 245 NHS hospitals. Occurrences and reasons for previous surgical cancellations were recorded. Using multilevel logistic regression, we identified patient- and hospital-level factors associated with cancellation due to inadequate bed capacity. Results: We analysed data from 14 936 patients undergoing planned surgery. A total of 1499 patients (10.0%) reported previous cancellation for the same procedure; contemporaneous hospital census data indicated that 13.9% patients attending inpatient operations were cancelled on the day of surgery. Non-clinical reasons, predominantly inadequate bed capacity, accounted for a large proportion of previous cancellations. Independent risk factors for cancellation due to inadequate bed capacity included requirement for postoperative critical care [odds ratio (OR)=2.92; 95% confidence interval (CI), 2.12–4.02; P<0.001] and the presence of an emergency department in the treating hospital (OR=4.18; 95% CI, 2.22–7.89; P<0.001). Patients undergoing cancer surgery (OR=0.32; 95% CI, 0.22–0.46; P<0.001), obstetric procedures (OR=0.17; 95% CI, 0.08–0.32; P<0.001), and expedited surgery (OR=0.39; 95% CI, 0.27–0.56; P<0.001) were less likely to be cancelled. Conclusions: A significant proportion of patients presenting for surgery have experienced a previous cancellation for the same procedure. Cancer surgery is relatively protected, but bed capacity, including postoperative critical care requirements, are significant risk factors for previous cancellations.

Original languageEnglish
Pages (from-to)730-738
Number of pages9
JournalBritish Journal of Anaesthesia
Volume121
Issue number4
Early online date7 Sept 2018
DOIs
Publication statusPublished - Oct 2018
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2018 British Journal of Anaesthesia (Open Archive)

Funder


SNAP-2: EPICCS was supported by the National Institute of Academic Anaesthesia (Association of Anaesthetists of Great Britain and Ireland Project grant): WKR0-2014-0061, the UCL/UCLH Surgical Outcomes Research Centre, the Royal College of Anaesthetists and the UCLH NIHR Biomedical Research Centre. The study is adopted in the UK onto the NIHR Clinical Research Portfolio and equivalents in the devolved nations, and supported by NIHR Local Clinical Research Networks. SRM and SKH are Improvement Science Fellows funded by the Health Foundation. SRM is supported for her role as Director of the NIAA Health Services Research Centre by funding from the Royal College of Anaesthetists. DJNW receives a clinical salary from The London Clinic hospital and a clinical research fellowship salary from the UCL/UCLH Surgical Outcomes Research Centre.

Funding Information:
SNAP-2: EPICCS was supported by the National Institute of Academic Anaesthesia (Association of Anaesthetists of Great Britain and Ireland Project grant): WKR0-2014-0061 , the UCL/UCLH Surgical Outcomes Research Centre, the Royal College of Anaesthetists and the UCLH NIHR Biomedical Research Centre . The study is adopted in the UK onto the NIHR Clinical Research Portfolio and equivalents in the devolved nations, and supported by NIHR Local Clinical Research Networks . SRM and SKH are Improvement Science Fellows funded by the Health Foundation. SRM is supported for her role as Director of the NIAA Health Services Research Centre by funding from the Royal College of Anaesthetists . DJNW receives a clinical salary from The London Clinic hospital and a clinical research fellowship salary from the UCL/UCLH Surgical Outcomes Research Centre.

Funding

SNAP-2: EPICCS was supported by the National Institute of Academic Anaesthesia (Association of Anaesthetists of Great Britain and Ireland Project grant): WKR0-2014-0061, the UCL/UCLH Surgical Outcomes Research Centre, the Royal College of Anaesthetists and the UCLH NIHR Biomedical Research Centre. The study is adopted in the UK onto the NIHR Clinical Research Portfolio and equivalents in the devolved nations, and supported by NIHR Local Clinical Research Networks. SRM and SKH are Improvement Science Fellows funded by the Health Foundation. SRM is supported for her role as Director of the NIAA Health Services Research Centre by funding from the Royal College of Anaesthetists. DJNW receives a clinical salary from The London Clinic hospital and a clinical research fellowship salary from the UCL/UCLH Surgical Outcomes Research Centre. SNAP-2: EPICCS was supported by the National Institute of Academic Anaesthesia (Association of Anaesthetists of Great Britain and Ireland Project grant): WKR0-2014-0061 , the UCL/UCLH Surgical Outcomes Research Centre, the Royal College of Anaesthetists and the UCLH NIHR Biomedical Research Centre . The study is adopted in the UK onto the NIHR Clinical Research Portfolio and equivalents in the devolved nations, and supported by NIHR Local Clinical Research Networks . SRM and SKH are Improvement Science Fellows funded by the Health Foundation. SRM is supported for her role as Director of the NIAA Health Services Research Centre by funding from the Royal College of Anaesthetists . DJNW receives a clinical salary from The London Clinic hospital and a clinical research fellowship salary from the UCL/UCLH Surgical Outcomes Research Centre.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

  1. SDG 3 - Good Health and Well-being
    SDG 3 Good Health and Well-being

Keywords

  • Health Services Research
  • medical resource utilisation
  • operating room management
  • surgery

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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