Clinical Professor of Surgery Rady Children's Hospital San Diego University of California San Diego, Department of Otolaryngology San Diego, California
Introduction: Same-day surgery cancellation is a significant issue, resulting in decreased operating room utilization, reduced surgeon productivity, and causing inconvenience for patients and families. In the adult literature, cancellation rates are reported between 4-14%. The aim of this study is to assess the cancellation rates of elective procedures at a tertiary pediatric academic hospital, identify common causes and evaluate changes with the COVID pandemic.
Methods: A retrospective review was conducted identifying all same-day cancellations from 1/1/2015 to 12/31/2017 (pre-COVID) and from 4/1/2020 to 3/31/2021 (post-COVID). Statistical analysis was performed using generalized regression with cancellation as the dependent variable. Period, age, ethnicity, gender, preferred language, and insurance were independent variables.
Results: There was a total of 55465 scheduled cases (41670 before and 13795 after COVID), with 1508 cancellations (2.7%). Of those, 1247 (3.0%) were before COVID and 261 (1.9%) after COVID (p < 0.0001). Of all cases, 56.7% (31475) were male, 55.1% (30595) were non-Hispanic/Latinx, 82.3% (45638) spoke English, and 45.5% (25237) had public insurance. The median age was 7.5, mean age was 8.5 years (SD=6.03). The decrease in the probability of cancellation after the onset of pandemic was most significant in patients who had public insurance, younger than 1 year of age, Hispanic/Latinx and spoke Spanish (pre-pandemic = 4.9% [CI=4.2% - 5.8%]; pandemic = 2.8% [95% CI =1.9% - 4.0%]. Regardless of the period, patients who had public insurance and those who were Hispanic/Latin had a higher rate of surgery cancellations (p < 0.0001).
Conclusion: There was a significant decrease in the rate of surgery cancellations post-pandemic, which was most evident in young Hispanic patients with public insurance whose families spoke Spanish. We hypothesize that the pre-operative mandatory COVID test 2 days prior to the surgery helped to minimize same-day cancellations. The increased nursing communication and education helped promote better family engagement and commitment to the surgery. The decrease in viral respiratory illnesses among children during the pandemic has also positively impacted the cancellation rates.