Surgery cancellations after entering the operating room
© The Author(s) 2016
Received: 6 August 2016
Accepted: 18 November 2016
Published: 25 November 2016
Surgery cancellation results in unavailability of the operating room and loss time. We identified the frequency of and reasons for operation cancellations after patients entered the operating room and assessed the preventability of such cancellations.
A retrospective chart review of all scheduled surgical procedures proposed under general anesthesia in a period spanning 2008 to 2016 was performed, and the reasons for cancellation were assessed.
A total of 30 surgery procedures were cancelled after the patient had entered the operation room and preparation for general anesthesia had been completed. Ten of 18 cases (55.6%) that were cancelled before general anesthesia induction could have been prevented, accounting for 36.7% of the overall cancellations. The majority of the cancellations after anesthesia were due to the patients’ health status.
Improving the systems for checking patients’ medical problems and performing preoperative evaluations can reduce the number of cancellations after the patient has entered the operating room.
KeywordsCancellation General anesthesia Surgery
Cancellations of surgery are costly and cause loss of hospital income. In addition, cancellations give a negative impression to patients. In particular, if a cancellation occurs after the patient has entered the operating room, it results in unnecessary costs and ineffective utilization of hospital resources and causes emotional distress to the patient. It is therefore necessary to reduce such cancellations as much as possible. Many studies have suggested methods for preventing cancellation of surgery due to patients’ medical problems, incomplete preoperative evaluations, system reasons, and other reasons [1, 2]. In this retrospective review of 30 cases with unexpected cancellation of surgery after the patient had entered the operating room, we analyze the indications for cancellations and offer suggestions for decreasing unexpected surgery cancellation.
The authors performed a retrospective chart review of all scheduled surgical procedures under general anesthesia between December 1, 2008, and April 30, 2016, at the Nippon Medical School Hospital. We selected records of any surgery that was cancelled after the patient had already entered the operating room, before or after the induction of general anesthesia. Information about the patient and the reason for cancellation were obtained from the anesthesia record system, ORSYS® (Philips Electronics Japan, Tokyo), and the hospital’s electronic medical records. The ethics committee of the Nippon Medical School approved this study.
Details of the patients’ characteristics of those who had their surgeries cancelled
Total (n = 30)
Mean age (years)
61.5 ± 22.1 (0.25–89)
Operating room time (minutes)
44.3 ± 48.8 (20–217)
ASA physical status
Surgery cancelled before anesthesia
Surgery cancelled after anesthesia
Operations cancelled by specialism
Operations cancelled by specialism
Total (n = 30)
Surgery of Critical Care Medicine Center
Electric convulsive therapy
Cases surgery cancelled before anesthesia and cause of cancellation.
Surgery cancellation reason
Prediction is difficult
Patient health status
Necessity of pacemaker check
Cases surgery cancelled after anesthesia and cause of cancellation
Surgery cancellation reason
Total (n = 12)
Our study highlights the role of insufficient evaluation of cases in which surgery is cancelled after the patient has entered the operating room. Several studies have shown the importance of preoperative anesthetic evaluation in the prevention of surgery cancellation [1–3]. Preoperative assessment by the anesthesiologist plays an important role in minimizing patient perioperative risk and preparation before surgery .
A Chinese study has reported that the rate of cancellations after patients entered the operating room was 0.21% . A study of cardiac surgical case cancellations in Massachusetts indicated that 0.84% of such surgeries were cancelled after the patient had entered the cardiac surgical operating room . In our study, the cancellation rate was less than 0.01%, which was relatively low. The probable reasons for this were as follows: there are very few day surgery cases in our hospital; all patients receiving general anesthesia should undergo a medical examination and evaluation by the anesthesiologist on the day before the operation [7, 8].
Our case review suggested that some of the cancellations could have been prevented or that the surgery could have been delayed before the patient entered the operating room and before anesthesia. In particular, the preoperative examinations planned by the attending surgeon should be checked, and vital signs at the ward should be confirmed by ward staff. A double-checking system could also be implemented, involving a nurse checking the essential preoperative examinations before the anesthesiologist does . Requests for medical devices, such as a pacemaker, should be confirmed the day prior to surgery; not doing so constitutes a lack of communication.
Based upon our study, we propose the following preoperative evaluations. Patients’ vital signs (blood pressure, heart rate, body temperature, and oxygen saturation) should be measured accurately at their ward by the ward nurse and should be checked by the anesthesiologist. A structured preoperative assessment has been reported to improve operating room efficiency and reduce surgery cancellations . A standardized preoperative evaluation checklist can also reduce the number of cancellations . Required preoperative examinations, such as 12-lead electrocardiogram, laboratory analysis, and chest X-ray, should be confirmed before surgery and double-checked whenever possible. The patients’ medical history should be shared, and communication among the medical staff should be optimal.
Surgery cancellations after induction of general anesthesia are difficult to prevent, as the main reason for such cancellations is sudden and unexpected changes in the patient’s condition, such as anaphylactic shock or arrhythmia.
There were several limitations to this study. This was a retrospective, single-facility study, and the information was obtained only from medical records. No statistical analysis was performed as the number of cancellation cases was small.
Improving the assessment of patients’ medical problems and preoperative evaluations can reduce the number of surgery cancellations after the patient has entered the operating room.
Disseminated intravascular coagulation
Percutaneous coronary intervention
We gratefully acknowledge the work of past and present members of our institution.
YH and AN conceived of the study and participated in its design and coordination. AS supported the management. All authors read and approved the final manuscript.
The authors declare that they have no competing interests.
Consent for publication
Ethics approval and consent to participate
The ethics committee of the Nippon Medical School approved this study.
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