Same-day Cardiac Surgery Cancellations at a Large UK Centre and Patient
Satisfaction Survey - Quality Improvement Study
Abstract
Background Same-day cancellation of cardiac surgeries is a disheartening
experience for patients. The primary aims of this study were to
determine the frequency and reasons for same-day cancellations, and
associated patients’ outcomes. The secondary aims were to evaluate
patients’ reactions to cancellations and to propose measures to reduce
cancellations. Methods We prospectively reviewed all elective and urgent
in-patient adult cardiac surgeries performed from August 2017 to March
2018. Procedures were divided into cancelled (C) and not cancelled (NC)
groups. A qualitative patient satisfaction survey was undertaken.
Results Overall, 1388 patients were scheduled for cardiac surgery during
this period. Elective surgeries constituted 70.7% (981/1388) and urgent
29.3% (407/1388). 231/1388 (16.7%) procedures were cancelled for the
following reasons: 30.5% lack of ITU beds, 20.1% patient medically
unfit, 8.2% ITU staff shortage, 6.9% emergency case intervention and
34.2% other. There was no significant difference in mortality between
groups (2.6% in C vs 1.6% in NC, p=0.62). In group C, 36% (84/231) of
patients underwent surgery within 72 hours of cancellation, 47%
(110/231) of procedures were rescheduled, and 6.9% (16/231) were not
performed. 30.7% (71/231) were potentially preventable. All cancelled
patients were asked to complete the survey; 43.7% (101/231) responded,
with 22.8% (23/101) describing feeling upset. However, 92.1% (93/101)
felt the cancellation was justified. Conclusion This single
institutional study suggests a relatively high number of planned
same-day surgeries are being cancelled. A third of these may be
preventable. Despite this, patients were understanding. Actions to
decrease cancellations should be identified to improve efficiency.