Cancelled operations: a 7-day cohort study of planned adult inpatient surgery in 245 UK National Health Service hospitals.
Wong DJN., Harris SK., Moonesinghe SR., SNAP-2: EPICCS collaborators None., Health Services Research Centre, National Institute of Academic Anaesthesia None., Study Steering Group None., Net Solving Limited None., Trainee Research Networks None., Abertawe Bro Morgannwg University Health Board None., Aintree University Hospitals NHS Foundation Trust None., Airedale NHS Foundation Trust None., Aneurin Bevan Health Board None., Ashford & St Peters NHS Foundation Trust None., Barking, Havering and Redbridge University Hospitals NHS Trust None., Barnsley Hospital NHS Foundation Trust None., Barts Health NHS Trust None., Basildon and Thurrock University Hospitals NHS Foundation Trust None., Bedford Hospital NHS Trust None., Belfast Health and Social Care Trust None., Betsi Cadwaladr University Health Board None., Birmingham Women's NHS Foundation Trust None., Blackpool Teaching Hospitals NHS Foundation Trust None., Bolton Hospital NHS Foundation Trust None., Bradford Teaching Hospitals NHS Foundation Trust None., Brighton and Sussex University Hospitals NHS Trust None., Buckinghamshire Healthcare NHS Trust None., Burton Hospitals NHS Foundation Trust None., Calderdale and Huddersfield NHS Foundation Trust None., Cambridge University Hospitals NHS Foundation Trust None., Cardiff and Vale University Health Board None., Central Manchester University Hospitals NHS Foundation Trust None., Chelsea and Westminster Hospital NHS Foundation Trust None., Chesterfield Royal Hospital NHS Foundation Trust None., Christie Hospital NHS Foundation Trust None., City Hospitals Sunderland NHS Foundation Trust None., Colchester Hospital University NHS Foundation Trust None., Countess of Chester NHS Foundation Trust None., County Durham and Darlington NHS Foundation Trust None., Croydon Health Services NHS Trust None., Cwm Taf University Health Board None., Dartford and Gravesham NHS Trust None., Derby Hospitals NHS Foundation Trust None., Doncaster and Bassetlaw Hospitals NHS Foundation Trust None., Dorset County Hospital NHS Foundation Trust None., Dudley Group NHS Foundation Trust None., East and North Hertfordshire NHS Trust None., East Kent Hospitals University NHS Foundation Trust None., East Lancashire Hospitals NHS Trust None., East Sussex Healthcare NHS Trust None., Epsom and St Helier University Hospitals NHS Trust None., Frimley Health NHS Foundation Trust None., Gateshead Health NHS Foundation Trust None., Gloucestershire Hospitals NHS Foundation Trust None., Great Western Hospitals NHS Foundation Trust None., Guy's and St Thomas' NHS Foundation Trust None., Hampshire Hospitals NHS Foundation Trust None., Harrogate and District NHS Foundation Trust None., Heart Of England NHS Foundation Trust None., Hillingdon Hospitals NHS Foundation Trust None., Homerton University Hospital NHS Foundation Trust None., Hull and East Yorkshire Hospitals NHS Trust None., Hywel Dda Health Board None., Imperial College Healthcare NHS Trust None., Ipswich Hospital NHS Trust 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None., NHS Shetland None., NHS Tayside None., Norfolk and Norwich University Hospitals NHS Foundation Trust None., Northampton General Hospital NHS Trust None., North Bristol NHS Trust None., North Cumbria University Hospitals NHS Trust None., Northern Devon Healthcare NHS Trust None., Northern Health and Social Care Trust None., Northern Lincolnshire and Goole Hospitals NHS Foundation Trust None., North Middlesex University Hospital NHS Trust None., North Tees and Hartlepool NHS Trust None., Northumbria Healthcare NHS Foundation Trust None., North West Anglia NHS Foundation Trust None., Nottingham University Hospitals NHS Trust None., Oxford University Hospitals NHS Foundation Trust None., Papworth Hospital NHS Foundation Trust None., Pennine Acute NHS Trust None., Plymouth Hospitals NHS Trust None., Poole Hospital NHS Foundation Trust None., Portsmouth Hospitals NHS Trust None., Princess Alexandra Hospital NHS Trust None., Queen Elizabeth Hospital NHS Foundation Trust None., Queen 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Hospital NHS Trust None., South Eastern Health and Social Care Trust None., Southport and Ormskirk Hospital NHS Trust None., South Tees Hospitals NHS Foundation Trust None., South Tyneside NHS Foundation Trust None., South Warwickshire NHS Foundation Trust None., St George's Healthcare NHS Trust None., St Helens and Knowsley Teaching Hospitals NHS Trust None., Stockport NHS Foundation Trust None., Surrey and Sussex Healthcare NHS Trust None., Tameside Hospital NHS Foundation Trust None., Taunton and Somerset NHS Foundation Trust None., Torbay and South Devon NHS Foundation Trust None., United Lincolnshire Hospitals NHS Trust None., University College London Hospitals NHS Foundation Trust None., University Hospital of North Midlands NHS Trust None., University Hospital of South Manchester NHS Foundation Trust None., University Hospitals Birmingham NHS Foundation Trust None., University Hospitals Bristol NHS Foundation Trust None., University Hospitals Coventry and Warwickshire NHS Trust None., University Hospitals of Leicester NHS Trust None., University Hospitals of Morecambe Bay NHS Foundation Trust None., University Hospital Southampton NHS Foundation Trust None., Walsall Healthcare NHS Trust None., Warrington & Halton Hospitals NHS Foundation Trust None., Western Health and Social Care Trust None., Western Sussex Hospitals NHS Foundation Trust None., West Herts Hospitals NHS Trust None., Weston Area Health NHS Trust None., West Suffolk NHS Foundation Trust None., Whittington Hospital NHS Trust None., Wirral University Teaching Hospital NHS Foundation Trust None., Worcestershire Acute Hospitals NHS Trust None., Wrightington, Wigan and Leigh NHS Foundation Trust None., Wye Valley NHS Trust None., Yeovil District Hospital NHS Foundation Trust None., York Teaching Hospital NHS Foundation Trust None.
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.