Incidence and reasons for cancellation on the day of elective surgery: a systematic review and meta-analysis.

INTRODUCTION

Cancellation on the day of elective surgery is a persistent challenge that compromises operating theatre efficiency, wastes resources and delays patient care. Existing evidence is difficult to interpret because definitions of cancellation vary across studies and reported reasons are classified inconsistently. We aimed to estimate the incidence of cancellation on the day of surgery and synthesise the reported reasons for cancellation.

METHODS

Databases were searched for observational studies reporting elective surgery cancellations. Studies explicitly defining cancellation on the day of surgery were included in a random-effects meta-analysis of proportions. Subgroup analyses examined variation by national income level and surgical speciality, with geographical region explored in supplementary analyses. Included studies were assessed for risk of bias using Joanna Briggs Institute critical appraisal tools. Reported reasons were synthesised narratively across four domains: patient; medical/anaesthesia; administrative/system; and surgery/staff.

RESULTS

Fifty-eight studies met the eligibility criteria, of which 37 (with a strict definition of on-the-day cancellation of surgery) were included. Pooled incidence of cancellation on the day of surgery was 14% (95%CI 13-16%), with substantial heterogeneity (I2 = 99.91%). Rates varied by national income level and surgical speciality, with higher estimates reported in low- and lower-middle-income settings and in some specialities, including ophthalmology and neurosurgery. Reasons reported most commonly included: patient declining surgery; non-fasted; unstable medical condition; changes in clinical status; improper scheduling or overbooking; instrument unavailability; and staff shortages. Sensitivity analyses supported the robustness of the findings and no clear publication bias was detected. The certainty of evidence for the pooled incidence estimate was low.

DISCUSSION: Cancellation on the day of surgery remains a substantial and globally relevant peri-operative problem. Its burden and drivers are highly context-dependent and often reflect weaknesses in pre-operative preparation, organisational co-ordination and system capacity. Reducing avoidable cancellations may therefore require context-specific strategies targeting pathway reliability, timely pre-anaesthetic assessment and peri-operative resource alignment.