Common Clinical Reasons for Canceling Surgery
Surgery cancellations are a common occurrence in clinical settings that can lead to disruptions in hospital operations, increased costs, and distress for patients. While some cancellations are unavoidable, many stem from modifiable medical and logistical factors. Understanding the most frequent clinical reasons for canceling surgery is essential for improving patient care and optimizing healthcare resource utilization.
One of the leading clinical reasons for canceling surgery is the presence of acute medical conditions that pose risks during anesthesia and surgery. Respiratory infections, such as pneumonia or upper respiratory tract infections, can lead to complications, especially in patients with underlying lung diseases. Similarly, cardiovascular instability, including uncontrolled hypertension or arrhythmias, may require postponing surgery until stabilization is achieved. Patients with newly diagnosed or poorly managed diabetes may also experience cancellations as a result of concerns over perioperative glucose control, which can affect wound healing and infection risk 1,2.
Patients undergoing elective procedures often require preoperative evaluations to ensure they are fit for surgery. Failure to complete necessary preoperative workups, such as laboratory tests, electrocardiograms, or imaging studies, can lead to last-minute cancellations. In addition, patients with specific conditions like anemia, malnutrition, or electrolyte imbalances may require optimization before proceeding with surgery. Conditions may warrant further investigations that delay the planned procedure, or they may not be sufficiently controlled, preventing the surgeon and anesthesia provider from proceeding with the procedure 3–7.
Active infections are often clinical reasons for canceling surgery, particularly when surgery involves implants or prosthetic devices. Infections such as urinary tract infections, skin infections, or systemic sepsis increase the risk of postoperative complications and may necessitate antibiotic treatment before proceeding with surgery. In the era of COVID-19 and other emerging infectious diseases, screening protocols for contagious illnesses have also contributed to the postponement of elective procedures 8–10.
Additionally, certain medications can interfere with surgical outcomes. Anticoagulants and antiplatelet drugs, commonly used in patients with cardiovascular diseases, increase the risk of excessive bleeding and often require temporary discontinuation before surgery. Similarly, patients on immunosuppressive therapies may face postponements to reduce the risk of poor wound healing and infection. In some cases, a failure to properly adjust medication regimens preoperatively can create safety concerns that are sufficient reasons for canceling or delaying surgery 11,12.
Surgery cancellations remain a challenge in clinical practice, often arising from acute medical conditions, inadequate preoperative optimization, infectious concerns, or medication-related issues. Addressing these factors through improved preoperative assessments, patient education, and interdisciplinary collaboration can minimize cancellations, enhance patient safety, and improve surgical outcomes. By identifying and mitigating these common causes, healthcare providers can reduce the burden of surgical delays and optimize perioperative care.
References
1. Tan, A. L. et al. Risk factors and reasons for cancellation within 24 h of scheduled elective surgery in an academic medical centre: A cohort study. International Journal of Surgery 66, 72–78 (2019). DOI: 10.1016/j.ijsu.2019.04.009
2. Engidayehu, T., Ayalew, Y., Gela, D. & Abera, F. Cancellation of Elective Surgery and Its Associated Factors in Public Teaching Hospitals of Addis Ababa, Ethiopia, 2021. SAGE Open 14, 21582440241300519 (2024). DOI: 10.1177/21582440241300519
3. Kaddoum, R., Fadlallah, R., Hitti, E., EL-Jardali, F. & El Eid, G. Causes of cancellations on the day of surgery at a Tertiary Teaching Hospital. BMC Health Serv Res 16, 259 (2016). DOI: 10.1186/s12913-016-1475-6
4. Koushan, M., Wood, L. C. & Greatbanks, R. Evaluating factors associated with the cancellation and delay of elective surgical procedures: a systematic review. International Journal for Quality in Health Care 33, mzab092 (2021). DOI: 10.1093/intqhc/mzab092
5. Naderi-Boldaji, V. et al. Incidence and root causes of surgery cancellations at an academic medical center in Iran: a retrospective cohort study on 29,978 elective surgical cases. Patient Saf Surg 17, 24 (2023). DOI: 10.1186/s13037-023-00377-6
6. Pattnaik, S., Dixit, S. K. & Bishnoi, V. The Burden of Surgical Cancellations: A Quality Improvement Study on the Importance of Preoperative Assessment. Cureus 14, e21731. DOI: 10.7759/cureus.21731
7. Dimitriadis, P. A., Iyer, S. & Evgeniou, E. The challenge of cancellations on the day of surgery. International Journal of Surgery 11, 1126–1130 (2013). DOI: 10.1016/j.ijsu.2013.09.002
8. COVIDSurg Collaborative. Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans. British Journal of Surgery 107, 1440–1449 (2020). DOI: 10.1002/bjs.11746
9. Yousra, O. et al. Analyzing the Causes and Consequences of Non-Compliance with the Operating Program and Their Consequences. Mathews Journal of Nursing and Health Care 5, 1–7 (2023). DOI: DOI : https://doi.org/
10. El‐Boghdadly, K. et al. SARS‐CoV‐2 infection, COVID‐19 and timing of elective surgery: A multidisciplinary consensus statement on behalf of the Association of Anaesthetists, the Centre for Peri‐operative Care, the Federation of Surgical Specialty Associations, the Royal College of Anaesthetists and the Royal College of Surgeons of England. Anaesthesia 76, 940–946 (2021). DOI: 10.1111/anae.15464
11. de Lorenzo-Pinto, A. et al. Cancellations of elective surgical procedures due to inadequate management of chronic medications. J Clin Pharm Ther 44, 561–564 (2019). DOI: 10.1111/jcpt.12816
12. Ziser, K. E. D., King, J. B., Alkass, N. & Dunsdon, J. E. Elective surgery cancellations due to suboptimal medicine management: a retrospective single site study. Journal of Pharmacy Practice and Research 53, 256–261 (2023). DOI: 10.1002/jppr.1876