One in seven major operations in UK cancelled on day of surgery, data shows

One in 10 patients waiting for surgery that involves a stay in hospital have already been cancelled on once before, according to seven-day snapshot

Patients waiting for complex surgery are more likely to find their procedure cancelled while those whose treatment can’t wait are prioritised (Getty)

The NHS cancels up to one in seven major surgeries on the day the patient is due to go under the knife, according to a one-week “snapshot” study on how staff and bed shortages are driving up waiting lists.

Increasing rates of last minute cancellations are “compounding patient stress” and creating extra costs for the health service, the researchers from the Royal College of Anaesthetists (RCA) and University College London (UCL) warn.

Some UK estimates have said just one in every 100 operations is cancelled, but that figure also includes minor and day case operations where patients will not need a bed to recuperate.

The latest snapshot, from a single week in spring 2017 where thousands of staff took steps to record detailed reasons for cancellations, shows that patients waiting for bigger operations involving an overnight stay are cancelled much more frequently.

Of these patients, 10 per cent have been cancelled once before, while patients waiting for riskier operations where they are likely to require a critical care bed to recover were also more likely to be cancelled on, the data shows.

This is partly down to the UK having fewer hospital beds than many other comparable high and middle income countries, and being in the midst of a staffing crisis with 100,000 posts currently advertised in England alone.

In response doctors are forced to prioritise emergency and time-sensitive surgeries – including cancer operations and births – meaning longer waits for those who are less urgent.

“Last minute cancellations of surgery affect the health and welfare of tens of thousands of patients in the UK every year,” said Professor Ramani Moonesinghe, who led the study published in the British Journal of Anaesthetics.

“It is positive that clinicians appear to appropriately prioritise the most urgent cases; however, it is clear that capacity issues, in particular resulting from competition for inpatient beds with emergency admissions, and the requirement for critical care after high risk surgery, substantially influence the risk of last minute surgical cancellation.”

Their study is published in the wake of a record winter crisis where in the first three months of 2018, 25,475 operations were cancelled on the day they were scheduled to take place in England alone – the highest since records began.

This is despite hospitals being told to pre-emptively cancel thousands of non-urgent operations to minimise same-day cancellations and focus resources on urgent cases.

For their research the RCA and UCL compiled data from an unparalleled 93 per cent of hospitals in England, Wales, Scotland and Northern Ireland and built a seven-day snap shot of surgeries that took place between 21 and 27 March.

It shows that of 26,171 inpatient operations, where a patient will require a bed to recover, there were 3,724 patients cancelled or postponed on the day their surgery was scheduled – 13.9 per cent.

Of these 28 per cent of the cancellations were recorded as medically justified, for example where patients were too unwell to be operated on.

One in 120 were cancelled directly because of a lack of beds, and the remainder were due to a mix of staff shortages, a lack of theatre capacity, equipment failure or logistical problems.

The authors said there are “no easy answers” for addressing this, and that each trust should look at the local data in the report and identify areas that are causing the biggest issues.

“Cancelling and rescheduling an operation is not only stressful for patients, but a complete waste of hospital resources – it is awful for a patient to have their operation cancelled twice,” said Professor Cliff Shearman, vice-president of the Royal College of Surgeons.

“The situation is getting worse,” he added. “Half a million patients are now waiting longer than 18 weeks and they are more likely to have their operation cancelled.

NHS England disputed the extrapolation of a one-week snapshot across a whole year, and said far fewer patients are rescheduled when all operations – including minor outpatient procedures – are included.

A spokesperson said: “Only a tiny minority of operations – just one in 100 – is cancelled on the day, and this report provides only a selective, limited snapshot of surgery in England, where the NHS is funding more routine operations and more people are undergoing treatment than the year before.”