Reasons for Surgery Cancellation on the Day of Surgery for Total Joint Arthroplasty Patients at John Peter Smith Hospital

Purpose: The aim of this study was to investigate reasons behind cancellations for knee and hip replacement patients at John Peter Smith (JPS) Hospital. We hope to identify any areas for improvement to help optimize patient outcomes and use of hospital resources. Methods: This is an incidence study consisting of knee and hip replacement surgical candidates and procedures during the 2018 calendar year. Retrospective chart review was completed and exploratory data analysis performed to categorize cases by reason(s) for cancellation. Results: There were 332 total scheduled procedures, of which 41 were cancelled. Reasons for cancellations were divided into the following categories: Abnormal test results accounted for the majority of cancellations (n=9, 21.95%). Development of a contraindication before the procedure accounted for 19.51% (n=8). Lack of available beds accounted for 14.64% (n=6). Equipment/implant/supply issues accounted for 14.64% (n=6). Surgeon/physician scheduling conflict accounted for 12.20% (n=5). Need for medical optimization accounted for 9.76% (n=4). Financial/insurance issues accounted for 2.44% (n=1). Surgical procedure no longer indicated accounted for 2.44% (n=1). Patient cancellation unrelated to medical or financial factors accounted for 2.4% (n=1). Conclusions: Of the significant cancellation reasons, there were two areas we identified as having potential for immediate improvement. These are the availability of hospital beds and problems with surgical equipment, implant, or supply. Based on these findings, the development and implementation of a plan to address these issues could potentially decrease the yearly cancellation rate by almost 30%.