Researchers recently investigated the cancellation rates of complex ophthalmic inpatient surgeries at a tertiary hospital in Beijing, China over a 10-year period. Their analysis aims to identify the reasons and associated factors for these cancellations and to provide insights into reducing cancellations and improving operating room efficiency.
Canceled inpatient surgeries come with negative implications, the researchers explain in an article published in Frontiers in Medicine, including detrimental effects on patients’ experiences and rapport with staff, costs that can double due to repeated examinations and readmission, and lost revenue. “Previous studies suggested the revenues lost were around $1,430 to $1,700 per hour due to surgery cancellation,” the authors explain, while “further studies estimated that the average cost per ophthalmic surgery cancellation was around $379.”
The investigators reviewed electronic medical records of inpatient ophthalmic surgery patients between 2012 and 2022, excluding ambulatory ophthalmic surgeries. Out of 42,893 scheduled surgeries, 1.9% were canceled. Glaucoma surgeries had a 4.8% cancellation rate, with a 4.6% rate for miscellaneous surgeries, a 3.9% rate for strabismus surgeries, and a 3.7% cancellation rate for oculoplastic surgeries.
Patients with ocular comorbidities and younger individuals were more likely to cancel surgeries. Conversely, older age, local residence, systemic comorbidities, and previous surgical history were linked to lower cancellation rates.
Medical factors were the leading cause of canceled inpatient surgeries (62%), followed by patient-related reasons (34.8%). Common reasons for cancellation included the refusal of surgery by patients or families (15.5%) and acute ocular conditions such as conjunctivitis or uveitis relapses (12.6%). The investigators name other factors that could cause a cancellation or a delay in inpatient surgeries, including patient compliance issues with preoperative preparation instructions, though they also note that these compliance issues are lower at their institution because of their protocols to admit patients the day before their surgery so they can be monitored according to guidelines.
They also discuss outpatient-based preoperative clinics (POCs), a care approach that has been found to be effective, partially-effective, and not effective in different studies. While POCs can be cost-effective for hospitals in reducing cancellations and associated costs, there are concerns that they increase medical costs for patients. Overall, while other solutions such as POCs are being explored, the researchers recommend creating better communication protocols between healthcare providers and patients to minimize preventable cancellations and delays.
A full list of author disclosures can be found in the published research.
