Background: There is a high variability in the reasons for cancellation of elective urological surgery cases. Case cancellation rate is expected to be high in the Public Health System with perceived inefficiencies compared to private facilities in the same developing economy. Aims and Objectives: This comparative analysis was to determine the case cancellation rate and the reasons for cancellation of elective urological surgeries in a public tertiary hospital and a private specialist hospital in Accra. This is intended to form a basis for interventions aimed at reducing the case cancellation rate. Methods: This was a retrospective analysis of prospectively collected data on Day of Surgery cancelled elective urological cases from September 2014 to October 2015 at the urology unit of the Korle-Bu Teaching Hospital (KBTH), a public Tertiary Hospital and the Trust Specialist Hospital (TSH), a privately managed hospital in Accra. The reasons for case cancellation were categorized into structural factors, patient factors and process factors. Results: There was no significant difference between the case cancellation rate for elective urological cases at KBTH and the TSH which were 20.8% and 17.1% respectively (p = 0.317). For KBTH, the reasons for cancellation of elective urological cases were due to structural factors in 11/117 (9.4%), patient factors in 15/117 (12.8%) and process factors in 91/117 (77.8%) which was due mainly to surgery running late. At the TSH, the reasons were due to structural factors in 1/29 (3.4%), patient factors in 27/29 (93.1%) mainly due to patient not turning up and process factors in 1/29 (3.4%). Conclusion: The case cancellation rate of elective urological surgeries in both the Public Tertiary Hospital and the Private Specialist Hospital were high with no significant difference between the two. However, in the Public Tertiary Hospital, process factors predominated as the cause of these cancellations while patient factors were the predominant cause in the privately managed facility. Exposure of theater managers in public facilities to management practices in privately run facilities should be encouraged to help improve the efficiency of the public facilities.
References
[1]
Dawlatly, A.A., Turkistani, A., Aldohayan, A., Zubaidi, A. and Ahmed, A. (2008) Reasons of Cancellation of Elective Surgery in a Teaching Hospital. The Internet Journal of Anesthesiology, 15, 2.
[2]
Tait, A.R., Voepel-Lewis, T., Munro, H.M., Gutstein, H.B. and Reynolds, P.I. (1997) Cancellation of Pediatric Outpatient Surgery: Economic and Emotional Implications for Patients and Their Families. Journal of Clinical Anesthesia, 9, 213-219.
https://doi.org/10.1016/S0952-8180(97)00032-9
[3]
Ivarsson, B., Kimblad, P.O., Sjoberg, T. and Larsson, S. (2002) Patient Reactions to Cancelled or Postponed Heart Operations. Journal of Nursing Management, 10, 75-81. https://doi.org/10.1046/j.0966-0429.2001.00293.x
[4]
Huda, F. (2014) A Retrospective Analysis of Reasons for Cancellation of Elective Surgery in a Teaching Hospital. International Journal of Scientific Reports, 2, 28-30.
[5]
Siemens, D.R., Schulze, K.M., Mackillop, W.J., Brundage, M.D. and Groome, P.A. (2005) A Population-Based Study of the Waiting Times for Prostatectomy in Ontario. Canadian Journal of Urology, 12, 2568-2574.
[6]
Kawakami, J., Hopman, W.M., Smith-Tryon, R. and Siemens, D.R. (2008) Measurement of Surgical Wait Times in a Universal Health Care System. Canadian Urological Association Journal, 2, 597-603. https://doi.org/10.5489/cuaj.974
[7]
Tait, A.R., Voepel-Lewis, T., Munro, H.M., et al. (1997) Cancellation of Pediatric Outpatient Surgery: Economic and Emotional Implications for Patients and Their Families. Journal of Clinical Anesthesia, 9, 213-219.
https://doi.org/10.1016/S0952-8180(97)00032-9
[8]
Leslie, R.J., Beiko, D., van Vlymen, J. and Siemens, D.R. (2013) Day of Surgery Cancellation Rates in Urology: Identification of Modifiable Factors. Canadian Journal of Urology, 7, 167-173. https://doi.org/10.5489/cuaj.1345
[9]
Jiménez, A., Artigas, C., Elia, M., Casamayor, C., Gracia, J.A. and Martinez, M. (2006) Cancellations in Ambulatory Day Surgery: Ten Years Observational Study. Ambulatory Surgery, 12, 119-123. https://doi.org/10.1016/j.ambsur.2005.09.002
[10]
Schofield, W.N., Rubin, G.L., Piza, M., Lai, Y.Y., Sindhusake, D., Fearnside, M.R, and Klineberg, P.L. (2005) Cancellation of Operations on the Day of Intended Surgery at a Major Australian Referral Hospital. The Medical Journal of Australia, 182, 612-615.
[11]
Sanjay, P., Dodds, A., Miller, E., Arumugam, P.J. and Woodward, A. (2007) Cancelled Elective Operations: An Observational Study from a District General Hospital. Journal of Health Organization and Management, 21, 54-58.
https://doi.org/10.1108/14777260710732268
[12]
Haana, V., Sethuraman, K., Stephens, L., Rosen, H. and Meara, J.G.L. (2009) Case Cancellations on the Day of Surgery: An Investigation in an Australian Paediatric Hospital. ANZ Journal of Surgery, 79, 636-640.
https://doi.org/10.1111/j.1445-2197.2009.05019.x
[13]
Donabedian, A. (1988) The Quality of Care. JAMA, 260, 1743-1748.
https://doi.org/10.1001/jama.1988.03410120089033
[14]
Jones, A.R., Sandison, A.J. and Owen, W.J. (1997) The Impact of Pre-Clerking Clinics on Surgical Operation Cancellations: A Prospective Audit. International Journal of Clinical Practice, 51, 294-295.
[15]
Aimakopoulos, G., Harrison, R. and Magnussen, P.A. (1998) Pre-Admission Clinic in an Orthopaedic Depart Department: Evaluation over a 6-Month Period. Journal of the Royal College of Surgeons of Edinburgh, 43, 178-181.
[16]
Schuster, M., Neumann, C., Neumann, K., Braun, J., Geldner, G., Martin, J., Spies, C. and Bauer, M. (2011) CASCAES Study Group. The Effect of Hospital Size and Surgical Service on Case Cancellation in Elective Surgery: Results from a Prospective Multicenter Study. Anesthesia & Analgesia, 113, 578-585.
https://doi.org/10.1213/ane.0b013e318222be4d
[17]
Chiu, C.H., Lee, A. and Chui, P.T. (2012) Cancellation of Elective Operations on the Day of Intended Surgery in a Hong Kong Hospital: Point Prevalence and Reasons. Hong Kong Medical Journal, 18, 5-10.
[18]
Macario, A. (2006) Are Your Hospital Operating Rooms “Efficient”? A Scoring System with Eight Performance Indicators. Anesthesiology, 105, 237-240.
https://doi.org/10.1097/00000542-200608000-00004
