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• W2899228332 abstract "Editor—We read with great interest the article by Wong and colleagues1Wong J.N. Harris S.K. Moonesinghe R.S. Cancelled operations: a 7-day cohort study of planned adult inpatient surgery in 245 UK National Health Service hospitals.Br J Anaesth. 2018; 121: 730-738Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar on the common worldwide problem of cancelled operations. Macario2Macario A. Are your hospital operating rooms “efficient”? A scoring system with eight performance indicators.Anesthesiology. 2006; 105: 237-240Crossref PubMed Scopus (150) Google Scholar has proposed an 8-point scoring system to determine operating theatre efficiency, in which having >10% cancellation rate signifies opportunities for improvement. Lau and colleagues3Lau H.K. Chen T.H. Liou C.M. Chou M.C. Hung W.T. Retrospective analysis of surgery postponed or cancelled inside the operating room.J Clin Anesth. 2010; 22: 237-240Crossref PubMed Scopus (27) Google Scholar identified surgery cancellation as a critical issue that resulted in financial and emotional stress to patients and their families, and opined that it should be treated in the same manner as a complication. The rates of surgical cancellations attributable to different risk factors are usually not clearly defined. Wong and colleagues1Wong J.N. Harris S.K. Moonesinghe R.S. Cancelled operations: a 7-day cohort study of planned adult inpatient surgery in 245 UK National Health Service hospitals.Br J Anaesth. 2018; 121: 730-738Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar concluded that NHS hospitals surveyed in the UK had a cancellation rate of ∼14%, and that many surgical cancellations were because of non-clinical reasons (∼53%). We wish to share our local experience in reducing the overall cancellation rate in a Singapore teaching hospital. The hospital average inpatient bed occupancy is >94% and the emergency workload is significant (31% of all operative patients in 2018). In addition to one to two emergency operating theatres daily, the hospital runs seven major operating theatres and six day surgery theatres from Monday to Friday (with the exception of elective obstetric, cardiothoracic, and paediatric patients). All patients are seen either in the preoperative anaesthesia clinic or in the wards before presenting for surgery. The operating theatre administration committee continuously tracks operation cancellation rate and discusses improvement measures with all stakeholders (including surgeons, anaesthetists, operations executives, and nursing) on a regular basis. A sprint audit data of cancellations performed over a 3-month period (April–June 2018) is compared (recognising that there will be inevitable differences) with UK NHS data reported by Wong and colleagues1Wong J.N. Harris S.K. Moonesinghe R.S. Cancelled operations: a 7-day cohort study of planned adult inpatient surgery in 245 UK National Health Service hospitals.Br J Anaesth. 2018; 121: 730-738Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar (Table 1). Of the 3186 patients scheduled, 196 (6.2%) were cancelled. Clinical reasons were the cause for 63.3% of all cancellations—about half because of recent upper respiratory tract infections and half because of un-optimised medical conditions. We had a much lower rate of cancellation for non-clinical reasons, with only one patient (0.5% vs 31%) lacking a critical care bed. There were no cases recorded that were linked to lack of equipment or staff availability. Only 2.4% of cancellations were for personal reasons in the NHS study compared with ours: 45 patients (23%) were cancelled because of personal reasons, which included patients' request to reschedule (24), patients no longer keen for surgery (15), financial concerns (five), and surgery performed in another hospital (one). This may possibly be because of the different healthcare financing systems in Singapore compared with free healthcare in the UK NHS. Singapore has a hybrid model of combined government subsidies with patient co-payment. Interestingly, Kyoung and Lee4Kim K.O. Lee J. Reasons for cancellation of elective surgery in a 500-bed teaching hospital: a prospective study.Korean J Anesthesiol. 2014; 67: 66-67Crossref PubMed Scopus (9) Google Scholar reported similar findings with a co-payment system, with patients' change of mind forming the majority of avoidable cancellations.Table 1Comparison of cancelled surgery between NHS hospitals and a Singapore hospital. OT, operating theatreReported reasonsUK NHS hospitals1Wong J.N. Harris S.K. Moonesinghe R.S. Cancelled operations: a 7-day cohort study of planned adult inpatient surgery in 245 UK National Health Service hospitals.Br J Anaesth. 2018; 121: 730-738Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar %Khoo Teck Puat hospital, Singapore % (196 patients cancelled), % (n)Clinical reasons (overall)33.363.3 Un-optimised medical conditions–32.7 (64) Upper respiratory tract infection–28.6 (56) Forgot to fast–2.0 (4)Non-clinical reasons (overall)52.636.7 Lack of beds310.5 (1) Insufficient OT capacity12.71.5 (3) Personal reasons2.423 (45) Equipment problem2.30 Staff unavailable2.20 Administrative error1.61 (2) Patient did not attend0.53.6 (7) Operation not required7.1 (14)Not known14.1– Open table in a new tab To mitigate some of the non-clinical reasons for cancellation, a senior consultant anaesthetist on duty in the operating theatre has a managerial role to coordinate and prioritise patients based on previously agreed criteria (including cancer surgery, fracture patients, patients in pain, previous cancellation, and special equipment). In addition, the hospital invests by employing a nurse (Monday–Friday) whose job is to make a phone call 1–3 days before the day of surgery to confirm the upcoming hospital visit for surgery. Wong and colleagues1Wong J.N. Harris S.K. Moonesinghe R.S. Cancelled operations: a 7-day cohort study of planned adult inpatient surgery in 245 UK National Health Service hospitals.Br J Anaesth. 2018; 121: 730-738Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar have indeed highlighted an important concern that affects all perioperative systems around the world. Organisations should customise improvement measures that work in the milieu of their healthcare infrastructure, healthcare funding, resources, culture, and practice. The two healthcare systems have intrinsic differences; a daily senior anaesthetist as clinical manager in Singapore may help reduce non-clinical reasons of operation cancellations compared with cancellation for lack of beds in the UK from one-third of the causes. A reasonable target for patient cancellation rate on the day of surgery may be benchmarked at <10%.2Macario A. Are your hospital operating rooms “efficient”? A scoring system with eight performance indicators.Anesthesiology. 2006; 105: 237-240Crossref PubMed Scopus (150) Google Scholar The authors declare that they have no conflicts of interest. Cancelled operations: a 7-day cohort study of planned adult inpatient surgery in 245 UK National Health Service hospitalsBritish Journal of AnaesthesiaVol. 121Issue 4PreviewCancellation 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. Full-Text PDF Open Archive" @default.
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• W2899228332 title "Cancelled operations. Comment on Br J Anaesth 2018; 121: 730–738" @default.
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