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. 2022 Jun 14;65(3):E382-E387.
doi: 10.1503/cjs.009420. Print 2022 May-Jun.

Cancellations and delays of emergent orthopedic operations at a Canadian level 1 trauma centre

Antoine Denis  1 , Julien Montreuil  2 , Edward J Harvey  2 , Gregory K Berry  2 , Rudolf Reindl  2 , Mitchell Bernstein  2
Affiliations

Cancellations and delays of emergent orthopedic operations at a Canadian level 1 trauma centre

Antoine Denis et al. Can J Surg. .

Abstract
in English, French

Background: Day-of surgery cancellation (DOSC) is considered to be a very inefficient use of hospital resources and results in emotional stress for the patient. To examine opportunities to minimize the incidence of preventable cancellations - an indicator of quality of care - we assessed the incidence of and reasons for DOSCs over 3 months among inpatients and outpatients at a trauma orthopedic service.

Methods: This was a prospective study of 2 cohorts of patients, inpatients and outpatients, scheduled for emergent orthopedic surgery at a Canadian tertiary level 1 trauma centre from Jan. 1 to Mar. 31, 2020. Patient demographic characteristics, injury characteristics, delays until surgery and reasons for DOSCs were recorded.

Results: A total of 185 patients (100 males and 85 females with a mean age of 54 yr) were included in the study. There were 98 outpatients and 87 inpatients. Seventy-five (40%) of the scheduled procedures in the outpatient group and 34 (30%) of those in the inpatient group were cancelled. In both groups, more than 85% of the cancellations were because of prioritization of a more urgent orthopedic or nonorthopedic surgical case. The average operative delay for the outpatient group was 11.4 days, compared to 3.8 days for the inpatient group (p < 0.001).

Conclusion: High DOSC rates were observed among both outpatients and inpatients. The main reason for delaying surgery was prioritization of a more urgent surgical case. Providing the orthopedic trauma service with a dedicated OR opened 6 days per week, along with extended hours of OR services to 1700 daily, might be effective at minimizing DOSCs.

Contexte:: Les annulations de chirurgie le jour même (ACJM) sont considérées comme une utilisation très inefficace des ressources, sans compter qu’elles entraînent souvent un stress émotionnel chez le patient. Pour explorer les moyens de réduire l’incidence des annulations évitables, un indicateur de la qualité des soins, nous avons mesuré l’incidence des ACJM et leurs motifs sur une période de 3 mois chez des patients hospitalisés ou non, dans un centre de traumatologie orthopédique.

Méthodes:: Il s’agit d’une étude prospective de 2 cohortes de patients, hospitalisés et non hospitalisés, qui devaient subir une intervention orthopédique urgente dans un centre de traumatologie canadien de niveau 1 entre le 1er janvier et le 31 mars 2020. Les caractéristiques démographiques des patients, les caractéristiques des lésions, les reports de chirurgie et les motifs des ACJM ont été consignés.

Résultats:: En tout, 185 patients (100 hommes et 85 femmes, âgés en moyenne de 54 ans) ont été inclus dans l’étude qui comptait 98 patients non hospitalisés et 87 patients hospitalisés. Soixante-quinze (40 %) des interventions prévues dans le groupe hospitalisé et 34 (30 %) dans le groupe non hospitalisé ont été annulées. Dans les 2 groupes, plus de 85 % des annulations ont été attribuées à la priorisation de cas plus urgents de chirurgie, orthopédique ou autre. Le report moyen des interventions dans le groupe de patients non hospitalisés a été de 11,4 jours, contre 3,8 jours dans le groupe de patients hospitalisés (p < 0,001).

Conclusion:: Des taux élevés d’ACJM ont été observés chez les patients hospitalisés et non hospitalisés. Le principal motif du report des chirurgies était la priorisation de cas plus urgents. Mettre à la disposition du service de traumatologie orthopédique un bloc opératoire dédié ouvert 6 jours sur 7 et prolonger les heures de fonctionnement des blocs opératoires à 1700 par jour pourrait réduire efficacement les ACJM.

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Conflict of interest statement

Competing interests: Mitchell Bernstein reports institutional research support from NXTSENS Microsystems and consulting fees from Smith & Nephew, NuVasive and Orthofix. He is a member of the Executive Board of the Limb Lengthening and Reconstruction Society. Edward Harvey reports grants or contracts from the Canadian Institutes of Health Research (CIHR), the US Department of Defense and the Natural Sciences and Engineering Research Council of Canada. He holds many patents outside the submitted work. He is a member of the Institute of Musculoskeletal Health and Arthritis Advisory Board, CIHR, and has played a leadership role for the Orthopaedic Trauma Association. He holds stock in MY01 and NXTSENS Microsystems, and has received equipment for performance of preclinical models from MY01. No other competing interests were declared.

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