One in seven National Health Service (NHS) hospital operations are being cancelled just before they are due to take place, often because of a lack of beds, staff or operating theatres, research reveals. The Guardian reports that according to the study, are based on the experience of patients at 90% of NHS hospitals across the UK, of 26,171 procedures due to take place during the last week of March this year, 3,724 (14%) of them were called off at or close to the time they were due to occur.
The results prompted fresh warnings that the delays were leading to patients suffering pain and distress when they had to wait longer than expected for their surgery and that the NHS was seriously short of the resources it needed to function properly. The report says the study also disclosed that patients were often denied surgery at the last moment because others who have come in to the hospital through A&E were judged to be in more urgent medical need.
An acute lack of beds in high-dependency and intensive care units contributes to cancellations. Patients who will need to spend time in either type of facility after their surgery, because they will need extra medical support as they recover, are three times more likely to experience their operation being cancelled than other groups awaiting surgery, the study found.
The authors, experts from the Royal College of Anaesthetists and the clinical outcomes centre at University College London, say the findings give the most in-depth picture yet as to why so many operations are postponed late in the day, which they say is an NHS-wide “intractable problem”.
“Last-minute cancellations of surgery affect the health and welfare of tens of thousands of patients in the UK every year,” said Professor Ramani Moonesinghe, the chief investigator of the SNAP-2: EPICCS project, which undertook the research in the report. “It is clear that capacity issues, in particular resulting from competition for inpatient beds with emergency admissions, and the requirement for critical care after high-risk surgery, substantially influence the risk of last-minute surgical cancellation,” she added.
One in 10 patients going to hospital for a planned, non-urgent operation had already had their procedure cancelled at least once before, the researchers found. During the last week of March 1,499 (10%) of the 14,936 patients who were due to have planned surgery were in that position.
While a third (499) of those 1,499 cancellations were caused by medical issues, the other two-thirds (1,000) happened for non-clinical reasons. Of those, 31% were due to a lack of beds, 12.7% to a shortage of operating theatre capacity, 2.3% to equipment problems and 2.2% due to staff being unavailable. Only 2.4% were for personal reasons and 0.5% because the patient did not attend.
The report says NHS England disputed the figures. A spokesperson said: “Actually, only a tiny minority of operations – just one in one hundred – is cancelled on the day, and this report provides only a selective, limited snapshot … the NHS is funding more routine operations and more people are undergoing treatment than the year before.”
Moonesinghe said her team had looked at operations cancelled for any reason, not just non-clinical reasons, and had also looked only at surgery that involved a spell in hospital rather than more minor procedures, in which patients often go home the same day.
Background: Cancellation 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.
Methods: We conducted a prospective observational cohort study over 7 consecutive days in March 2017 in 245 NHS hospitals. Occurrences and reasons for previous surgical cancellations were recorded. Using multilevel logistic regression, we identified patient- and hospital-level factors associated with cancellation due to inadequate bed capacity.
Results: We analysed data from 14 936 patients undergoing planned surgery. A total of 1499 patients (10.0%) reported previous cancellation for the same procedure; contemporaneous hospital census data indicated that 13.9% patients attending inpatient operations were cancelled on the day of surgery. Non-clinical reasons, predominantly inadequate bed capacity, accounted for a large proportion of previous cancellations. Independent risk factors for cancellation due to inadequate bed capacity included requirement for postoperative critical care [odds ratio (OR)=2.92; 95% confidence interval (CI), 2.12–4.02; P<0.001] and the presence of an emergency department in the treating hospital (OR=4.18; 95% CI, 2.22–7.89; P<0.001). Patients undergoing cancer surgery (OR=0.32; 95% CI, 0.22–0.46; P<0.001), obstetric procedures (OR=0.17; 95% CI, 0.08–0.32; P<0.001), and expedited surgery (OR=0.39; 95% CI, 0.27–0.56; P<0.001) were less likely to be cancelled.
Conclusions: A significant proportion of patients presenting for surgery have experienced a previous cancellation for the same procedure. Cancer surgery is relatively protected, but bed capacity, including postoperative critical care requirements, are significant risk factors for previous cancellations.
DJN Wong, SK Harris, SR Moonesinghe on behalf of the SNAP-2: EPICCS collaborators
[link url="https://www.theguardian.com/society/2018/sep/07/nhs-cancels-14-of-operations-at-last-minute-research-finds"]The Guardian report[/link]
[link url="https://bjanaesthesia.org/article/S0007-0912(18)30565-8/fulltext"]British Journal of Anaesthesia abstract[/link]