gms | German Medical Science

Objectives/Interrogation: Retrospective cohort study of emergency surgery cancellations in a busy tertiary plastic surgery centre. The primary objective was to calculate the cancellation rate. Further patient-specific data was extracted to evaluate for preventable cancellations and introduce departmental changes to improve the service.

Methods: Review of all cancellations in emergency plastic surgery over a three month period from May to August 2018. Data pertaining to patient demographics, proposed surgical procedure and reason for cancellation were extracted from both electronic and paper records. Both the cancellation rate and the average delay in surgical intervention as a result of the cancellation were calculated.

Results and Conclusions: 157 cancellations were identified. 67% of these were cancelled on the day of surgery and 33% were cancelled in advance via the phone and having the dates of their surgical appointments changed. The overall cancellation rate was 19.1%, with 13% of patients being cancelled on the day of their proposed operation. 5.4% of cases were cancelled on more than one occasion. More than half of all cancellations required further surgical appointments and their surgery was delayed by an average of 2.22 days as a result. The most common reasons for same day cancellations were as follows: operation not necessary, surgical list overbooking and patients not attending their appointments. A sub-analysis of operations cancelled on the grounds of not being clinically warranted revealed that infections, fractures and fingertip injuries were the most common. Patients who failed to attend their appointments were more frequently young males with small injuries and no functional deficit.

At 13%, our same day cancellation rates are in keeping with similar studies in the field. Our study also incorporated patients who were cancelled a few days in advance of their surgery and found that almost 20% of all patients who get scheduled to undergo emergency plastic surgery will have this appointment changed. A large proportion of cancellations were due to the operation being not necessary - we have addressed this issue by introducing formal teaching sessions and improving availability of senior clinicians in the decision making process. Furthermore, we have also optimised several administrative processes to further minimise cancellation rates.