Non-Compliance with the Operating Program: Analyzing the Causes and Consequences: A Case Study

Ouhammou Yousra *

Department of Visceral Surgery, Military Hospital Mohammed V, Faculty of Medicine and Pharmacy of Rabat, Morocco.

Laamri Imad

Department of Visceral Surgery, Military Hospital Mohammed V, Faculty of Medicine and Pharmacy of Rabat, Morocco.

Maouni Ilyass

Department of Visceral Surgery, Military Hospital Mohammed V, Faculty of Medicine and Pharmacy of Rabat, Morocco.

Boussaidane Mohammed

Department of Traumato Orthopedic Surgery, Military Hospital Mohammed V, Faculty of Medicine and Pharmacy of Rabat, Morocco.

Elmoukhtari Kamal

Department of Traumato Orthopedic Surgery, Military Hospital Mohammed V, Faculty of Medicine and Pharmacy of Rabat, Morocco.

Abou elalaa Khalil

Department of Anesthesiology and Intensive Care, Head of the Operating Room Theatre Military Hospital Mohammed V, Faculty of Medicine and Pharmacy of Rabat, Morocco.

*Author to whom correspondence should be addressed.


Abstract

Background: Surgical scheduling in hospitals is critical to optimize surgical activity and ensure quality of care. Surgical scheduling can be affected by a variety of factors leading to cancellation or delay of surgical procedures, which can result in financial and personal hardship for patients and their families. The study aimed of to identify the incidence and causes of non-adherence to the surgical schedule in the operating room of the Mohammed V Military Teaching Hospital in Rabat, Morocco.

Methods: We analyzed the medical records of patients admitted for surgery over a 12-month period. Data collected included the number of scheduled, canceled, and added surgeries, epidemiological data of the patients, pathologies involved, reasons for cancellation and addition, and patient outcomes.

Results: We analyzed a total of 3023 scheduled surgeries, of which 215 (7.11%) were cancelled and 167 (5.6%) were added. Neurosurgery was the most frequently cancelled surgical specialty. The most common reasons for cancellation were infection, decompensation of a chronic pathology, and lack of availability of the operating room. Orthopedic surgery was also the most affected specialty in the added surgeries, mostly due to surgical emergencies. Our analysis of patient demographics revealed that the average age of cancelled surgery patients was 52.16 ± 14.6 years, with a male predominance of 63.25%. Based on ASA classification, 57.6% of patients were classified as ASA I, 33.48% as ASA II, and only 8.84% as ASA III. Medical and anesthesia-related causes accounted for 30 cancellations, with anesthesia contraindications (13.3%) and abnormal test results (40%) being the most common reasons. Surgery-related causes accounted for 22 cancellations, with non-availability of the surgeon (50%) being the most frequent reason. Patient-related causes accounted for 55 cancellations, with non-compliance with pre-anesthesia treatment (58.18%) being the most common reason. Organizational causes accounted for 108 cancellations, with equipment failure (40.7%) being the most frequent reason.

Conclusion: This review demonstrates that the main causes for surgery cancellation can be controlled by hospital managers, who can aim to improve areas such as patient flow and capacity management. Ultimately, this will improve the quality of health care delivered by hospitals.

Keywords: Non-compliance, operating program, cancellation, hospital management, patient outcomes, resource availability


How to Cite

Yousra , Ouhammou, Laamri Imad, Maouni Ilyass, Boussaidane Mohammed, Elmoukhtari Kamal, and Abou elalaa Khalil. 2023. “Non-Compliance With the Operating Program: Analyzing the Causes and Consequences: A Case Study”. Asian Journal of Research in Surgery 6 (2):71-79. https://journalajrs.com/index.php/AJRS/article/view/134.

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References

Tan AL, Chiew CJ, Wang S, Abdullah HR, Lam SS, Ong ME, Tan HK, Wong TH. Risk factors and reasons for cancellation within 24 h of scheduled elective surgery in an academic medical centre: A cohort study. Int J Surg. 2019;66:72-78. DOI: 10.1016/j.ijsu.2019.04.009. Epub 2019 Apr 26. PMID: 31029875.

Koushan M, Wood LC, Greatbanks R. Evaluating factors associated with the cancellation and delay of elective surgical procedures: a systematic review. Int J Qual Health Care. 2021;33(2):mzab092.

DOI: 10.1093/intqhc/mzab092. PMID: 34100548.

Armoeyan M, Aarabi A, Akbari L. The effects of surgery cancellation on patients, families, and staff: a prospective cross-sectional study. J Perianesth Nurs. 2021;36(6):695-701.e2. DOI: 10.1016/j.jopan.2021.02.009. Epub 2021 Sep 24. PMID: 34565663.

Kaddoum R, Fadlallah R, Hitti E, El-Jardali F, El Eid G. Causes of cancellations on the day of surgery at a Tertiary Teaching Hospital. BMC Health Serv Res. 2016;16:259. DOI: 10.1186/s12913-016-1475-6. PMID: 27412041; PMCID: PMC4944432

Schofield WN, Rubin GL, Piza M, Lai YY, Sindhusake D, Fearnside MR, Klineberg PL. Cancellation of operations on the day of intended surgery at a major Australian referral hospital. Med J Aust. 2005;182(12):612-5.

DOI: 10.5694/j.1326-5377.2005.tb06846.x. PMID: 15963016.

Lankoande M, Bonkoungou P, Traore S, Kabore R, Ouangre E, Pendeville P. Cancellation of elective surgical procedures in the university teaching hospital center Yalgado Ouedraogo in Burkina Faso: Incidence, reasons and proposals for improvement. South African J Anaesth Analg. 2016;22:140 4.

Schuster M, Neumann C, Neumann K, Braun J, Geldner G, Martin J, Spies C, Bauer M. CASCAES Study Group. The effect of hospital size and surgical service on case cancellation in elective surgery: results from a prospective multicenter study. Anesth Analg. 2011;113(3):578-85. DOI: 10.1213/ANE.0b013e318222be4d. Epub 2011 Jun 16. PMID: 21680860.

Garg R, Bhalotra AR, Bhadoria P, Gupta N, Anand R. Reasons for cancellation of cases on the day of surgery-a prospective study. Indian J Anaesth. 2009;53(1):35-9. PMID: 20640075; PMCID: PMC2900031.

Dimitriadis PA, Iyer S, Evgeniou E. The challenge of cancellations on the day of surgery. Int J Surg. 2013;11(10):1126-30. DOI: 10.1016/j.ijsu.2013.09.002. Epub 2013 Sep 12. PMID: 24035905.

Chiu CH, Lee A, Chui PT. Cancellation of elective operations on the day of intended surgery in a Hong Kong hospital: point prevalence and reasons. Hong Kong Med J. 2012;18(1):5-10. PMID: 22302904.

Kim KO, Lee J. Reasons for cancellation of elective surgery in a 500-bed teaching hospital: a prospective study. Korean J Anesthesiol. 2014;67(1):66-7. DOI: 10.4097/kjae.2014.67.1.66. PMID: 25097743; PMCID: PMC4121499.

Cihoda JH, Alves JR, Fernandes LA, de Souza Neto EP. The analysis for the causes of surgical cancellations in a Brazilian university hospital. Care Manag J. 2015;16(1):41-7. DOI: 10.1891/1521-0987.16.1.41. PMID: 25918776.

Solak AK, Pandza H, Beciragic E, Husic A, Tursunovic I, Djozic H. Elective case cancellation on the day of surgery at a general hospital in Sarajevo: causes and possible solutions. Mater Sociomed. 2019;31(1):49-52.

DOI: 10.5455/msm.2019.31.49-52. PMID: 31213956; PMCID: PMC6511384.

Solak AK, Pandza H, Beciragic E, Husic A, Tursunovic I, Djozic H. Elective case cancellation on the day of surgery at a general hospital in sarajevo: causes and possible solutions. Mater Sociomed. 2019;31(1):49-52.

DOI: 10.5455/msm.2019.31.49-52. PMID: 31213956; PMCID: PMC6511384

Laisi J, Tohmo H, Keränen U. Surgery cancelation on the day of surgery in same-day admission in a Finnish hospital. Scand J Surg. 2013;102(3):204-8. DOI: 10.1177/1457496913492626. PMID: 23963036.

McKendrick DR, Cumming GP, Lee AJ. A 5-year observational study of cancellations in the operating room: Does the introduction of preoperative preparation have an impact? Saudi J Anaesth. 2014;8(Suppl 1):S8-S14.

DOI: 10.4103/1658-354X.144053. PMID: 25538529; PMCID: PMC4268536.

Chalya PL, Gilyoma JM, Mabula JB, Simbila S, Ngayomela IH, Chandika AB, Mahalu W. Incidence, causes and pattern of cancellation of elective surgical operations in a university teaching hospital in the Lake Zone, Tanzania. Afr Health Sci. 2011;11(3):438-43. PMID: 22275936; PMCID: PMC3261008.

Abate SM, Chekole YA, Minaye SY, Basu B. Global prevalence and reasons for case cancellation on the intended day of surgery: A systematic review and meta-analysis. Int J Surg Open. 2020;26:55-63.

DOI: 10.1016/j.ijso.2020.08.006. Epub 2020 Aug 20. PMID: 34568611; PMCID: PMC7440086.

Ogwal A, Oyania F, Nkonge E, Makumbi T, Galukande M. Prevalence and predictors of cancellation of elective surgical procedures at a Tertiary Hospital in Uganda: a cross-sectional study. Surg Res Pract. 2020;2020:1464098.

DOI: 10.1155/2020/1464098. PMID: 32258365; PMCID: PMC7115171.

Hänninen-Khoda L, Koljonen V, Ylä-Kotola T. Patient-related reasons for late surgery cancellations in a plastic and reconstructive surgery department. JPRAS Open. 2018;18:38-48.

DOI: 10.1016/j.jpra.2018.08.002. Erratum in: JPRAS Open. 2021 Sep 24;30:174-175. PMID: 32158836; PMCID: PMC7061671.

Chung F, Mezei G. Factors contributing to a prolonged stay after ambulatory surgery. Anesth Analg. 1999;89(6):1352-9. DOI: 10.1097/00000539-199912000-00004. PMID: 10589607.

Dexter F, Epstein RH. Typical savings from each minute reduction in tardy first case of the day starts. Anesth Analg. 2009;108(4):1262-7. DOI: 10.1213/ane.0b013e31819775cd. PMID: 19299798.

Epstein RH, Dexter F. Management implications for the perioperative surgical home related to inpatient case cancellations and add-on case scheduling on the day of surgery. Anesth Analg. 2015;121(1):206-218.

DOI: 10.1213/ANE.0000000000000789. PMID: 26086516.

Desta M, Manaye A, Tefera A, Worku A, Wale A, Mebrat A, Gobena N. Incidence and causes of cancellations of elective operation on the intended day of surgery at a tertiary referral academic medical center in Ethiopia. Patient Saf Surg. 2018;12:25. DOI: 10.1186/s13037-018-0171-3. PMID: 30154916; PMCID: PMC6109985.

Madani A, Watanabe Y, Bilgic E, Pucher PH, Vassiliou MC, Aggarwal R, Fried GM, Mitmaker EJ, Feldman LS. Measuring intra-operative decision-making during laparoscopic cholecystectomy: validity evidence for a novel interactive Web-based assessment tool. Surg Endosc. 2017;31(3):1203-1212.

DOI: 10.1007/s00464-016-5091-7. Epub 2016 Jul 13. PMID: 27412125.

Van der Meijden OA, Schijven MP. The value of haptic feedback in conventional and robot-assisted minimal invasive surgery and virtual reality training: a current review. Surg Endosc. 2009;23(6): 1180-90.

DOI: 10.1007/s00464-008-0298-x. Epub 2009 Jan 1. PMID: 19118414; PMCID: PMC2686803.