Abstract
Purpose: :
To report the incidence and identify the causes of cancellation of cataract extraction surgery at an urban, university hospital.
Methods: :
A retrospective review of resident surgical case records and patient medical records from January 2008 to December 2008.
Results: :
A total of 89 cases scheduled for cataract extraction were cancelled prior to surgery in this 12 month period. Ten identifiable reasons for cancellation were documented in the surgical case record or patients chart. In 5 instances no identifiable reason for cancellation could be found. 29 (32%) of cancellations were secondary to lack of pre-operative medical clearance. Preoperative medical clearance was cited as a reason if the patient had not yet seen there primary medical practitioner as directed by the ambulatory surgery pre-operative assessment and/or the patient failed to get subspecialty evaluation as directed by their primary medical practitioner before surgery (e.g. Cardiology). Only 2 patients were denied medical clearance for cataract extraction. 18 (20%) patients cancelled surgery for personal reasons. 11 (12%) cases were cancelled secondary to symptoms/signs systemic disease on the day of surgery. 9 ( 10%) were cancelled due to insurance problems. Other causes for cancellations included continued aspirin prescription prior to surgery (4.4%), surgical day ocular symptoms/signs (2%), failure to show for preoperative testing (6.6%), cancelled secondary to surgical emergency (2%), failure to show for surgery (2%), and eating the morning before surgery (1%).
Conclusions: :
The most common cause of cataract surgery cancellation at our institution was a lack of preoperative medical clearance. Postponement by patients, signs and symptoms systemic illness, and lack of insurance coverage were also identified as major causes of case cancellation. As ACGME requirements have doubled the minimum requirements of cataract surgery for ophthalmology residents, understanding etiologies of case cancellation is paramount to implementing systems-based strategies to prevent resident case attrition, patient inconvenience and operating room inefficiency.
Keywords: clinical (human) or epidemiologic studies: systems/equipment/techniques • clinical (human) or epidemiologic studies: health care delivery/economics/manpower • clinical (human) or epidemiologic studies: biostatistics/epidemiology methodology