Non-medical risk factors associated with postponing elective surgery: a prospective observational study

• Published in: BMC medical ethics 2021-07, Vol.22 (1), p.1-90, Article 90
• Main Authors: Becker, Julia, Huschak, Gerald, Petzold, Hannes-Caspar, Thieme, Volker, Stehr, Sebastian, Bercker, Sven
• Format: Article
• Language: English
• Subjects: Age groups; Bioethics; Cancellation of surgery; Cancer; COVID-19; Elective surgery; Gender; Health insurance; Hospitals; Management; Medical appointments and schedules; Native languages; Nursing homes; Observational studies; Operating rooms; Operation room management; Pain; Patients; Personal relationships; Planning; Questionnaires; Risk factors; Schedules; Scheduling; Undertreatment
• ISSN: 1472-6939; 1472-6939
• DOI: 10.1186/s12910-021-00660-0

Operation room (OR) planning is a complex process, especially in large hospitals with high rates of unplanned emergency procedures. Postponing elective surgery in order to provide capacity for emergency operations is inevitable at times. Elderly patients, residents of nursing homes, women, patients with low socioeconomic status and ethnic minorities are at risk for undertreatment in other contexts, as suggested by reports in the medical literature. We hypothesized that specific patient groups could be at higher risk for having their elective surgery rescheduled for non-medical reasons. In this single center, prospective observational trial, we analysed 2519 patients undergoing elective surgery from October 2018 to May 2019. A 14-item questionnaire was handed out to illicit patient details. Additional characteristics were collected using electronic patient records. Information on the timely performance of the scheduled surgery was obtained using the OR's patient data management system. 6.45% of all planned procedures analysed were postponed. Association of specific variables with postponement rates were analysed using the Mann-Whitney U test and Fisher's exact test/[chl].sup.2-test. Significantly higher rates of postponing elective surgery were found in elderly patients. No significant differences in postponing rates were found for the variables gender, nationality (Germany, EU, non-EU), native language, professional medical background and level of education. Significantly lower rescheduling rates were found in patients with ties to hospital staff and in patients with a private health insurer. Elderly patients, retirees and nursing home residents seem to be at higher risk for having their elective surgery rescheduled. However, owing to the study design, causality could not be proven. Our findings raise concern about possible undertreatment of these patient groups and provide data on short-term postponement of elective surgery.