Incidence and Associated Factors of Same-Day No-Shows for Elective Day Surgery: A Retrospective Cohort Study of 79,516 Patients

BACKGROUND: Same-day surgical no-shows disrupt operating room efficiency and waste valuable medical resources, yet data from large day-surgery cohorts in China remain limited. This study investigated the incidence and associated factors of same-day no-shows among elective day-surgery patients. METHODS: The authors conducted a retrospective cohort study of 79,516 elective day-surgery patients at a tertiary hospital in Zhejiang Province, China, from January 2023 to June 2024. Demographic, clinical, and surgical data were extracted from electronic health records. Univariate analyses and multivariate logistic regression were performed to identify independent predictors of same-day no-show. Restricted cubic spline modeling was used to assess the nonlinear relationship between preoperative waiting time and no-show risk, with subgroup analyses stratified by gender and surgical grade. RESULTS: The overall no-show rate was 2.53% (n=2009). Higher surgical grade, general or neuraxial anesthesia, otolaryngology, gynecology, and urology departments, surgeries led by attending physicians, procedures scheduled in winter, on Mondays, or on public holidays, and longer preoperative waiting times were independently associated with higher no-show risk. The restricted cubic spline model revealed a nonlinear association between preoperative waiting time and no-show risk, with an inflection point around 7 days. Waiting less than 7 days was protective, whereas longer intervals increased the risk progressively. CONCLUSIONS: Prolonged preoperative waiting time (>7 d) is a modifiable determinant of same-day no-show. Targeted scheduling optimization and strengthened preoperative communication for high-risk groups may help reduce no-show rates and improve surgical efficiency.