Beyond the Operating Room: Preventing Elective Surgical Cancellations Through Preoperative Optimization and Integrated Healthcare Management

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Avoidable elective surgical cancellations represent a persistent challenge for healthcare systems, affecting patient safety, continuity of care, operating room efficiency, and institutional resource utilization. This narrative review aimed to analyze the clinical, organizational, and administrative factors associated with surgical cancellations and examine preventive strategies involving preoperative assessment, individualized clinical optimization, and multidisciplinary healthcare management. International and Latin American scientific literature was critically synthesized using a structured analytical approach supported by the Define–Measure–Analyze–Improve–Control (DMAIC) framework. The reviewed evidence demonstrated considerable variability in reported cancellation frequencies, ranging from 2.7% to 19.91% among selected institutional investigations, while international meta-analyses reported pooled estimates of 14%–18%. Administrative and structural factors, insufficient preoperative preparation, unstable medical conditions, and patient-related circumstances emerged as important contributors. Structured preoperative assessment was consistently associated with lower cancellation frequencies in several observational studies, with reported differences depending on institutional characteristics and assessment modalities. Multidisciplinary interventions were also associated with reductions in selected preventable cancellation outcomes, although findings varied according to study design and analytical approach. Evidence from Mexico, Colombia, and Brazil highlighted the importance of considering regional healthcare infrastructure and organizational constraints. The review identified methodological heterogeneity, inconsistent definitions of preventability, and limited prospective evidence as important restrictions on direct comparisons and causal interpretation. Integrating anesthesiology, internal medicine, and healthcare administration within coordinated perioperative pathways may support the identification of modifiable risk factors, improved surgical scheduling, and more efficient resource allocation. Nevertheless, prevention strategies must distinguish avoidable disruptions from clinically justified postponements. Sustainable improvement requires standardized performance indicators, interdisciplinary collaboration, and continuous quality monitoring, with patient safety remaining the primary consideration in surgical decision-making.