Background and Objectives: Elective surgery cancellations can lead to increased costs, reduced resource utilization, and patient and surgeon dissatisfaction. The reasons for why these cancellations occur remain poorly understood, hindering interventions to prevent their occurrence. Understanding these factors is necessary to implement effective strategies to reduce cancellation rates and improve surgical care delivery. This study aimed to identify the reasons for elective surgery cancellation and how these reasons can be efficiently addressed to reduce cancellation rates.

Methods & Study Design The study focused on the General Surgery outpatient service at Grady Memorial Hospital, affiliated with Morehouse School of Medicine. We compiled a list of all requested elective surgical cases and documented the number of cases completed versus those canceled and the reasons for cancellations. Data collection occurred from July 1, 2023, to December 29, 2023. Following the appointment of a pre-procedure coordinator, a second set of data was collected from January 1, 2024, to April 22, 2024.

The reasons for cancellations were categorized into patient-related factors (e.g., no-shows, call-in cancellations, non-adherence to NPO status, failure to stop anticoagulation, unexpected illness), surgeon-related factors, missed preoperative anesthesia visits, financial clearance issues, and unknown reasons. We applied a one-sample chi-square goodness-of-fit test to calculate the chi-square statistic for data analysis. Additionally, we conducted a cost analysis to estimate the missed revenue based on average CMS reimbursements for the respective procedures. Using the collected dataset, we extrapolated the potential missed revenue over the course of a year if current trends continued.

Results During the first five months of the study, 48 elective cases were canceled, representing approximately 30% of the scheduled elective cases. Most of these cancellations (60%) were due to missed pre-anesthesia testing or appointments (PAT) and other patient-related factors.

Following the appointment of a surgery center scheduler to assist with elective cases, there were no missed PAT appointments during the second data collection period in 2024. However, patient-related factors still accounted for most cancellations in 2024, constituting 69.2%.

Cancellations were also categorized as "intervenable" versus "non-intervenable" to evaluate the impact of system-wide deficits. Notably, 66% of the canceled cases were due to "intervenable" reasons, such as patients not showing up for scheduled pre-anesthesia testing because they were unaware of the appointments.

For the first data set, the calculated chi-square value (χ²) was 18.750, greater than the critical value of 15.09 for a degree of freedom (df) of 5, with p = 0.002. The chi-square value for the second data set was 28.462, exceeding the critical value of 11.34 for a degree of freedom (df) of 3, with p < 0.001.

Conclusions Since the calculated chi-square values exceed the critical values in both instances, we reject the null hypothesis (H₀), which posits that the observed proportions of surgery cancellations due to different factors are consistent with the expected proportions. This indicates that the observed proportions of surgery cancellations due to multiple dependent factors are inconsistent with the expected proportions, and the findings are statistically significant, not attributable to random chance.

The reasons for surgery cancellations differ significantly from the expected patterns based on the sample data. However, there remains a gap in the system for keeping patients informed about their pre-operative appointments and the overall pre-operative process after scheduling elective surgery. A dedicated outpatient surgery coordinator could help bridge this gap by facilitating more frequent and direct communication between patients and providers, potentially increasing the number of completed scheduled surgeries. Nonetheless, non-intervenable reasons for cancellations, such as unannounced no-shows and new onset medical conditions, will persist as challenges in elective surgery care due to their unpredictable nature and lack of easily identifiable solutions.