Why are thoracic operations postponed?

Evaluating factors associated with the cancellation and delay of elective surgical procedures: a systematic review

BACKGROUND

Elective surgery cancellation is considered a fundamental problem in health care services-it causes considerable disruption to patient flow, further eroding often already stretched operating capacity, and consequentially reduces both hospital performance and patient satisfaction. This research presents a systematic review (SR) of the reasons for surgery cancellation among different hospitals and countries. By highlighting these causes, we identify how to reduce cancellations, thereby improving the use of surgical capacity and resources and creating a more predicable patient flow.

METHODS

An SR was performed on elective surgery cancellation in compliance with the Preferred Reporting Items for Systematic Review and Meta-Analysis and by assessing the methodological quality of SR with Measurement Tool to Assess Systematic Reviews guidelines.

RESULTS

There are different reasons for surgery cancellation that vary between hospitals. This SR demonstrates that hospital-related causes (e.g. unavailable operation room time, inappropriate scheduling policy and lack of beds) are the primary reason for surgery cancellation, followed by work-up related causes (e.g. medically unfit and changes in the treatment plan) and patient-related causes (e.g. absence of a patient and patient refusal).

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 healthcare delivered by hospitals.

Structure and function of a perioperative anticoagulation management clinic

BACKGROUND

The perioperative management of patients who are receiving an anticoagulant and require a surgery/procedure is well-informed by multiple clinical studies, but an assessment of the delivery of such management is lacking. Describing the structure and function of a perioperative anticoagulation clinic provides a model for delivery of such patient care.

METHODS

We examined the operational model of a perioperative anticoagulation clinic. We describe the processing and management of patients receiving anticoagulant therapy who require elective surgery or procedure, including anticoagulant interruption, resumption and consideration for bridging therapy. We also describe the patient profile assessed over an 18-month period, and the potential benefits of this clinic to patients for perioperative management and education.

RESULTS

During an 18-month period, 1061 patients were assessed. Atrial fibrillation and venous thromboembolism were the most common indications for anticoagulant therapy, comprising 55.0% and 26.5% of patients, respectively; 44.1% of patients were taking warfarin, 37.1% were taking direct oral anticoagulants, and 12.3% were receiving low-molecular-weight heparin. The key components of this clinic model emphasizes a patient-centered approach to perioperative anticoagulant management based on evidence-based management protocols, alongside patient and family education that is delivered by a multi-disciplinary team approach.

CONCLUSIONS

Our perioperative anticoagulation clinic model provides one approach to the delivery of perioperative anticoagulant management, with the potential to optimize patient safety, improve patient education, and minimize health care costs.