Last-minute cancellation of adult patients scheduled for cardiothoracic surgery in a large Dutch tertiary care centre

Q: What are the key findings of this study?

Medically related last-minute cancellations of elective cardiac surgery significantly increased 1-year mortality compared to no cancellation (12.8% vs 5.4%; HR 2.50, 95% CI 1.30-4.78; P=0.006).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Elective cardiothoracic surgery (n=2111). Intervention: Medically related last-minute surgery cancellation vs. No cancellation. Primary outcome: 1-year mortality (HR 2.50, 95% CI 1.30-4.78, p=0.006).

Q: What does this research mean for the field?

Medically related last-minute cancellations of cardiothoracic surgery independently double the risk of one-year mortality compared to no cancellation. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Bart Scheenstra; Anouk M A Princée; Maike Imkamp; Bas Kietselaer; Yuri M. Ganushchak; Arnoud W.J. van ’t Hof; Jos G. Maessen

doi:10.1093/ejcts/ezab246

April 23, 2021European Journal of Cardio-Thoracic SurgeryOpen Access

Last-minute cancellation of adult patients scheduled for cardiothoracic surgery in a large Dutch tertiary care centre

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Key result

Medical cancellation of elective cardiac surgery is linked to ~2.5-fold higher 1-year mortality.

HR 2.50
95% CI 1.30-4.78
P=0.006
n=2,111

Figures

Why the study?

Unanticipated surgical cancellations cause distress and increase healthcare costs, but limited evidence exists on the effects of last-minute cancellations specifically in cardiothoracic surgery.

Does last-minute cancellation of cardiothoracic surgery increase the risk of adverse medical outcomes in adult patients?

Key Points

To assess the incidence and drivers of last-minute cancellations in elective cardiothoracic surgery and examine their association with subsequent adverse outcomes.
Evaluated 2111 consecutive adult patients scheduled for elective cardiothoracic procedures between January 2017 and June 2019 at a Dutch tertiary care centre.
Categorized last-minute cancellations into medically related causes (e.g., active infection, worsening comorbidities) and process-related causes (e.g., staffing shortages, lack of ICU beds, urgent emergency cases).
Compared rescheduling proportions, waiting intervals, and 30-day and 1-year mortality between cancelled patients and those operated on without delay.
Last-minute cancellations occurred in 301 of 2111 patients (14.3%), with 215 cancellations (71%) being process-related and 78 (26%) medically related.
Process-related cancellations were rescheduled in 98.6% of cases (median delay 5 days) compared with 71.8% of medically related cancellations (median delay 13 days; P < 0.001).
One-year mortality reached 12.8% (10 deaths) after medically related cancellations versus 5.4% (98 deaths) without cancellation (unadjusted HR 2.50; 95% CI, 1.30–4.78; P = 0.006; remained significant after EuroSCORE II adjustment), whereas process-related cancellation mortality was 3.3% (7 deaths; unadjusted HR 0.60; 95% CI, 0.28–1.28; P = 0.185).

Study Design

Type

Cohort (n=2,111)

Multicenter

No

Structured PICO

Does last-minute cancellation of cardiothoracic surgery increase the risk of adverse medical outcomes in adult patients?

P

Population

2,111 adult patients (mean age ~69 years, 30.4% female) admitted for elective cardiac surgery at a Dutch tertiary center, excluding emergency and non-cardiac procedures, followed for 1 year.

E

Exposure

Last-minute cancellation of surgery (medically related or process related)

C

Comparator

No cancellation

O

Outcome

1-year mortality and rescheduling rateshard clinical

Main Result

Hazard Ratio: 2.5 (95% CI 1.3–4.78)

Absolute Event Rate: 12.8% vs 5.4%

p-value: p=0.006

Last-minute cancellations of cardiothoracic surgery for medical reasons are associated with significantly higher 1-year mortality.

Limitations

Retrospective, single-centre study design
Information about cancellations was retrieved from printed timetables, resulting in unknown cancellation reasons for 8 patients
Subjective qualitative classification of reasons for cancellation
Lack of uniform definition of last-minute cancellation in the literature makes comparison across studies difficult
Patient experience and psycho-social health impact were not measured

Implication

May prompt strategies to minimize cancellations; leaves open whether prevention improves survival.

Abstract

OBJECTIVES: Unanticipated cancellation of a surgical procedure is a common problem, causing distress to the patient and increases in healthcare costs. However, limited evidence exists on the effects of last-minute cancellations of cardiothoracic surgical procedures in particular. The goal of this study was to gain insight into the prevalence of and the reasons for last-minute cancellations and to examine whether cancellation is associated with adverse medical outcomes. METHODS: Patients who were scheduled for elective cardiothoracic surgical procedures between January 2017 and June 2019 were evaluated. The reasons for the cancellations were assigned to the categories medically related or process related. We examined the differences in patient characteristics between those designated as no cancellation, medically related cancellations and process-related cancellations. Lastly, we examined the outcomes of patients who experienced a last-minute cancellation of a scheduled operation. RESULTS: A total of 2111 patients were included; of these, 301 (14.3%) had last-minute cancellations. In 78 (26%) cases, the cancellations were attributable to medical reasons (e.g. infection, comorbidities); 215 (71%) of the cancellations were process related (e.g. another patient in more urgent need of surgery, lack of staff). Almost 99% of the operations with a process-related cancellation were rescheduled compared to only 71.8% of the medically related cancelled operations (P < 0.001). Patients with a medically related cancellation had significantly higher 1-year mortality than patients who had no cancellation (unadjusted hazard ratio 2.50; 95% confidence interval, 1.30-4.78; P = 0.006); after adjustment for the EuroSCORE II, this effect remained significant. CONCLUSIONS: Last-minute cancellations were commonly seen in our cohort, and the reasons for cancellation were significantly related to adverse medical outcomes.

Discussion

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Cite This Study

Scheenstra et al. (2021) conducted a cohort in Elective cardiothoracic surgery (n=2,111). Medically related last-minute surgery cancellation vs. No cancellation was evaluated on 1-year mortality (HR 2.50, 95% CI 1.30-4.78, p=0.006). Medically related last-minute cancellations of elective cardiac surgery significantly increased 1-year mortality compared to no cancellation (12.8% vs 5.4%; HR 2.50, 95% CI 1.30-4.78; P=0.006).

synapsesocial.com/papers/6a75dfa4212a5a9b7b7070f3 https://doi.org/10.1093/ejcts/ezab246

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Last-minute cancellation of adult patients scheduled for cardiothoracic surgery in a large Dutch tertiary care centre

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Last-minute cancellation of adult patients scheduled for cardiothoracic surgery in a large Dutch tertiary care centre

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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