The analysis for the causes of surgical cancellations in a Brazilian university hospital.

Background: The aim of our study is to quantify the occurrence of suspension of scheduled surgeries in a Brazilian university hospital, trying to identify the causes of suspension of these operations and meet the medical specialties that most contributed to the cancellation.Methods: This study takes the form of an exploratory, descriptive, and quantitative enquiry carried out by analyzing the database from 2008 to 2011 of the operating theater.Results: Of the 29,518 scheduled surgeries, 16.1% were cancelled. The patient was the main reason, accounting for more than 40% of all suspensions. When calculating the rate of surgery suspended from a specialty, dividing the number of cancelled surgeries in a specialty by the number of scheduled surgeries in the same, we found that otolaryngology is the specialty with the highest rate of 21.3%.Conclusions: One of the main reasons in our sample why surgeries were cancelled is nonappearance of the patient. Improving communication between patient and hospital facilitates the client program and also contributes to avoid cancellations.Keywords: cancellations of scheduled surgeries; health services; operating rooms; university hospitalImproving the quality of help and efficiency of service offered to the population has been a constant concern to health care institutions. To monitor quality and productivity and the impact of health care programs, institutions use management tools known as indicators (Perroca, Jerico, & Facundin, 2007b).The surgical center is the focal point of numerous activities in a hospital because it links with most medical services (Canales & Macario, 2001). The performance of a surgical procedure is a matter of great importance in the life of a patient, involving psychological, physical, and social aspects for the individual (Barbeiro, 2010; Pittelkow & Carvalho, 2008). During this time, the patient experiences different emotions such as anxiety, distress, tension, stress, and fear of anesthesia and, in particular, of death. The patients worry about the length of time they will be out of their usual family and work routine and about the financial resources available to them to cope with this stressful period of life (Barbeiro, 2010).The parameters to evaluate productivity in the operating theater are the occupancy rate, the length of time spent in surgery, recovery from anesthesia, length of time between operations, rate of delay, and suspension of surgery (Gatto & Jouclas, 1998; Ministerio de Saude, 2002).The rate of suspension of surgery is one of the criteria used to evaluate efficiency and quality of care given by the surgical service (Landim et al., 2009). All the reasons for suspending surgery must be taken into consideration in the construction of this indicator, such as lack of materials, the doctor being delayed, the patient not fully prepared, preliminary examinations not carried out, a lack of beds in intensive care, inadequate administrative planning, and so forth (Perocca et al., 2007b).. Studies show the rate of suspension of surgery can range from 5% to 33% (Cavalcante, Pagliuca, & Almeida, 2000; Garg, Bhalotra, Bhadoria, Gupta, & Anand, 2009; Guillen et al., 2012; Paschoal & Gatto, 2006; Perroca et al., 2007b).Cancellation often makes it difficult to deal with the patient's feelings, a situation made worse according to the individual circumstances of each case because the same circumstance can trigger different reactions in different people. Everyone reacts in his or her own particular way to a given situation (Pittelkow & Carvalho, 2008). Studies carried out to identify patients' reactions to this situation have shown a sense of outrage, distrust of the surgical team, insecurity and intense distress, negative feelings and resignation, and concern about inability to control of the situation (Perroca et al., 2007b). So, suspension of the procedure means prolonging these feelings which impact on the patients' quality of life (Landim et al. …