Bipin Malkania
Introduction
Same-day cancellation of elective surgery is a persistent challenge in peri-operative care, negatively impacting theatre efficiency, healthcare costs, and patient experience. A proportion of these cancellations are avoidable. This audit aimed to identify key causes of on-the-day cancellations in a day-surgery unit and assess the impact of targeted pathway interventions.
Methods
A retrospective two-cycle audit was conducted in the Surgical Day Care Centre of a district general hospital. Cycle 1 reviewed same-day cancellations between April and September 2024 (n=102), excluding procedures under local anaesthesia. Contributing factors were analysed to identify avoidable causes. Interventions included enhanced patient and staff guidance, pre-operative telephone confirmation, 24-hour theatre list validation, and introduction of reserve patient lists. Cycle 2 re-audited cancellations between July and December 2025 (n=109).
Results
Cycle 1 identified avoidable causes including non-attendance, inadequate fasting, and failure to follow pre-operative instructions. Following intervention, fasting-related cancellations reduced by 50% (4 to 2), and patient attendance improved with pre-operative confirmation calls. In Cycle 2, cancellations were predominantly due to non-modifiable factors, particularly acute patient illness, indicating a shift away from avoidable causes. Theatre overruns were most frequent in gynaecology, while some ENT procedures were deemed unnecessary on the day. Anaesthetic staffing contributed to 12 cancellations.
Conclusions
Simple, low-cost pathway interventions were associated with a measurable reduction in avoidable cancellations and a shift towards non-modifiable causes. These findings support the implementation of structured pre-operative processes to improve theatre utilisation, operational efficiency, and patient experience in day-surgery settings.
Authors
Aruna Muthulingam, Bipin Malkania, Sukhpal Bijral, Larisa Maris
Medway Maritime Hospital, Gillingham, United Kingdom