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Health Services Research & Development

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2009 HSR&D National Meeting Abstract

National Meeting 2009

1007 — Effect of Comorbidities and Incomplete Evaluation on Elective Surgery Cancellation: A Case for Coordinated Multidisciplinary Preoperative Evaluation

Argo JL (REAP, Birmingham VA Medical Center, Birmingham, AL; University of Alabama at Birmingham), Vick CC (REAP, Birmingham VA Medical Center, Birmingham, AL; University of Alabama at Birmingham), Itani KM (VA Boston Health Care System, West Roxbury, MA; Boston University), Bishop MJ (VA Central Office, Washington, DC; Puget Sound VA Health Care System, Seattle; University of Washington, Seattle), Hawn MT (REAP, Birmingham VA Medical Center, Birmingham, AL; University of Alabama at Birmingham)

The cancellation of elective surgery due to inadequate workup or suboptimal control of medical comorbidities results in inefficient use of resources, patient inconvenience, and delayed access to surgical care. The cost impact of medical/work-up (MW) case cancellations (CC) on VA operating rooms is estimated to be at least $775 per cancellation. The purpose of this study is to identify the rate of CC due to MW issues for the VA system.

Operative CC data from FY2006 were collected from the VISTA software package at 123 VA medical centers. Variables collected from each facility include: number, reason, and service for each CC. Analyses were performed on six surgical specialities: general, vascular, cardiothoracic (CT), opthalmology, orthopedic, and urology. Unique CC reasons were placed into 6 broad categories: MW, anesthesia, facility, patient, surgeon, and miscellaneous. Univariate analysis was performed to describe the population. Rates were arcsin transformed to make comparisons with site as the unit of analysis. Kruskal Wallis tests were used to compare transformed CC rates by specialty and reason.

Of the 290,210 scheduled surgical cases in the six specialities evaluated, 36,044 (12.4%) were cancelled. CC rates varied by speciality: vascular (18.2%), CT (17.5%), urology (13.5%), general surgery (11.8%), orthopedic (11.1%), and ophthalmology (9.2%) (p < 0.001). There were 10,202 CC due to MW issues comprising 28.3% of all cancellations. The proportion of CC rates attributed to MW varied by specialty: vascular (37.1%), CT (35.3%), urology (23.0%), general surgery (26.1%), orthopedic (32.8%), and ophthalmology (27.5%) (p < 0.0001). The cost to the VA system for inefficiency due to cancelled cases for MW reasons is estimated to be approximately $8,000,000 annually.

Compared with general surgery, cardiothoracic and vascular surgery have significantly higher CC rates that can be attributed to higher MW CCs. This is likely due to the increased rate of complex comorbidities in this patient population. These patients would benefit from a coordinated multidiscipliary preoperative evaluation likely leading not only to fewer cancellations of elective procedures, but also to overall improved surgical outcomes.

Patients undergoing elective cardiac or vascular procedures should have a team approach to ensure optimization for surgical procedures.

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