1.2. MATERIALS METHODS
This prospective audit was performed between August 2017 and March 2018.
The research is reported in line with the Standards for Quality
Improvement Reporting Excellence (SQUIRE)
guidelines.11
Adult patients undergoing elective and urgent cardiac surgery were
included in our study. Those who underwent emergency or non-cardiac
procedures and patients under the age of 18 were excluded. Patients were
identified on a weekly basis from theatre registers and printed
operating lists. Same day surgery cancellations were defined as any
postponement of patients’ operation once listed for surgery.
Electronic hospital records were reviewed, and the following information
was recorded for all patients: demographics; scheduled surgery date;
EuroSCORE II and its components; admission type (elective/urgent
in-house/transfer patient); date of pre-operative anaesthetic review.
Additionally, reasons for cancellation, timing of cancellation
(pre-operative/during anaesthesia/intraoperative) and outcomes including
time from cancellation to performed operation; hospital stay
post-cancellation and mortality were recorded. Procedures were divided
into cancelled (C) and non-cancelled (NC) groups for analysis.
The reasons for cancellation were categorized into: lack of ITU beds and
nurses; patient medically unfit; scheduling error; patient-related
issues; emergency intervened; procedure no longer needed; lack of
perfusionist; incomplete investigations; surgeon unavailable; transfer
issue; theatre staff shortage. Patient-related issues included failure
to stop medication and treatment refusal. Scheduling errors included
overrunning cases, overbooking of the operating room, late operation
start and IT errors.
We further assessed the impact of cancellations on patient satisfaction
and wellbeing. Patients completed a questionnaire by telephone 3 months
after discharge to allow time to reflect. Questionnaire data assessed
adherence to Association of Anaesthetists of Great Britain and Ireland
Theatre Efficiency guidance, including healthcare professionals
informing patients; time offered for explanation; patient understanding
and satisfaction as well as perception of being kept nil by mouth (NBM)
longer than necessary (Figure 1). This questionnaire has previously been
used by Wasim et al. to assess patient experience following cancelled
orthopaedic surgery.12 A pilot study was conducted to
validate its content.
All data was entered into a Microsoft Excel spreadsheet. Statistical
analysis consisted of determination of the mean and range for continuous
data and percentage quantification for the categorical data. Statistical
significance was established using chi-squared test and two-sided
unpaired student t-test with p values <0.05 considered
significant. The study was approved by the on-site Trust Ethics and
Quality Improvement Committee. As this was a quality improvement project
and information collected did not include personal identifiers,
individual consents were not required.