Factors that influence an anesthesiologist's decision to cancel elective surgery for the child with an upper respiratory tract infection

Abstract

Study objective: To examine factors that anesthesiologists consider when making decisions regarding elective surgery cancellation of the pediatric patient with an upper respiratory infection (URI).

Design: Questionnaire survey.

Setting: Anesthesiology departments and/or practices throughout the United States.

Participants: 212 anesthesiologist members of the Society for Pediatric Anesthesia (SPA).

Measurements and main results: A total of 400 questionnaires were mailed to anesthesiologists randomly selected from the membership of the SPA. Of these questionnaires, 212 (54%) were completed and returned. Of these respondents, 71 (34.5%) reported that they seldom (1% to 25% of the time) cancelled cases due to an URI, and 43 (20.9%) stated that they usually (76% to 99% of the time) cancelled in the event of an URI. Two respondents (1%) reported never cancelling due to an URI, and six (2.9%) stated that they always cancelled. Frequency of cancellation was independent of type of practice. However, anesthesiologists who had been in practice for more than 10 years were significantly more likely to cancel than those who had been in practice for less than 10 years (p < 0.05). Factors that were considered most important in making decisions regarding cancellation included the urgency of the surgery and the presence of asthma. Other important considerations included fear of complications and the anesthesiologist's previous experience anesthetizing children with URIs. Factors related to the economics and inconvenience of cancellation did not influence the decision to cancel surgery. These factors included distance traveled, cost of cancellation, attitude of the parents, fear of litigation, and pressure to complete cases expediently.

Conclusions: The results of this survey demonstrate a wide range of opinions and approaches to this enduring clinical dilemma. However, it appears that the practice of cancelling elective surgery for children with URIs may be changing over time, since younger anesthesiologists appear to cancel less often than their more experienced counterparts. It is hoped that this information will be useful to practioners in their evaluation and management of children with colds and will stimulate further investigation into this important clinical problem.