Factors associated with elective surgical case cancellation at a tertiary hospital in Malawi

Background: Same-day cancellation of surgery affects up to 44% of cases at a public tertiary hospital in Lilongwe, Malawi. To characterize these cancellations, this study examines surgical volume, cancellation causes, and surgery completion rate after initial cancellation, which are not otherwise monitored for analysis in this setting.

Methods: We conducted a serial cross-sectional study at the Kamuzu Central Hospital (KCH) during a 6 month period. Variables included patient demographics, procedure information, and hospital capacity factors. Bivariate and multivariable regression models were constructed to assess factors associated with cancellation.

Results: Of the 3121 total surgeries, 2626 (84.1%) were elective procedures, of which 747 (28.4%) were canceled. Orthopedic surgery observed the highest cancellation rate (36.5%). Process-related factors, such as starting cases late, were the primary reason for cancellation (64.3%). Only 40% of patients with a canceled surgery underwent their procedure after index admission, with a median wait time of 3 days. Emergency cases (aOR: 0.50 and CI: 0.39 and 0.64) and first cases of the day (aOR: 0.02 and CI: 0.01 and 0.04) were associated with lower odds of cancellation. Facility factors associated with lower odds of cancellation included number of open operating rooms (OR: 0.86 and CI: 0.77 and 0.96) and anesthetists assigned on duty (OR: 0.94 and CI: 0.88 and 0.99).

Conclusion: Cancellation of elective surgery was primarily driven by process-related factors. We identify facility-related factors associated with lower odds of cancellation and thus provide targets for future interventions at KCH. Studies examining patient outcomes following elective case cancellation are warranted as most patients never return for surgery following cancellation.