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A139
October 18, 2008
9:00 AM - 11:00 AM
Room Hall E2-Area G,
Cancellations: for Richer, for Poorer . . .
Neil Ray, Avery Tung, M.D., Sharon Jakubczyk, David B. Glick, M.D., M.B.A.
Anesthesia & Critical Care, University of Chicago, Chicago, Illinois
Introduction: Case cancellations occurring on the day of surgery (DOS) can adversely impact Operating Room (OR) efficiency and increase hospital costs. The ability to prospectively identify risk factors for cancellations may reduce the incidence of these cancellations. In previous work we demonstrated that patient-related variables account for more than 50% of DOS cancellations at an academic medical center1. One interesting question is whether DOS cancelled patients differ from patients whose cases are not cancelled with respect to their socioeconomic status. To test this hypothesis, we compared the income, education, and poverty status of patients cancelled on the DOS with a control group of randomly selected patients who were not cancelled.

Methods: After IRB approval, we prospectively identified all patients from October 2005 to May 2006 who were cancelled on the DOS. Data collected included procedure, date, cancellation reason, and patients' demographic data. We then identified the average income, education level, and poverty status for each patient's zip code using the U.S Census Bureau database. Similar data were also obtained for an equal group of randomly selected patients who actually underwent surgery during the same period. Multivariate logistic regression was used to compare income, education level, and poverty status data between the two groups. All data were analyzed using STATA (StataCorp LP, College Station, TX).

Results: Over an 8-month period, 945 DOS cancellations were identified out of 10,792 procedures scheduled, for a cancellation rate of 8.8%. We found that a patient was less likely to have a DOS cancellation if he or she lived in an area with the least percentage of residents below the poverty level (Odds ratio = 0.53, p < 0.03). Interestingly, the average income level and education status of an area did not produce any statistically significant results.[table1]Discussion: Identifying patients at risk for cancellations on the day of surgery and targeting interventions at these “high risk” patients may improve OR efficiency and reduce costs. Patients that lived in an area with the lowest percentage of residents below the poverty line had a decreased propensity for DOS cancellations. Therefore, interventions may be targeted towards patients that live in areas with a higher percentage of residents below the poverty level.

References:

1Anesthesiology 2006; 105:A1289.

Anesthesiology 2008; 109 A139
Cancellation risk by Income, Education and Poverty Level
Demographic VariablesCancellation Odds Ratiop-value95% C.I.
Income
80-120% medianREFREFREF
0-40% median1.070.8460.541-2.119
40-80% median1.360.1070.936-1.972
120-160% median1.500.0670.972-2.302
>160% median1.570.1660.830-2.955
%Bachelor's Degree
80-120% medianREFREFREF
0-40% median1.030.8920.712-1.477
40-80% median1.200.2620.873-1.647
120-160% median0.970.9060.619-1.529
>160% median1.070.7100.736-1.568
%Below Poverty
80-120% medianREFREFREF
0-40% median0.530.0290.301-0.936
40-80% median0.730.1570.479-1.127
120-160% median1.050.8430.662-1.656
>160% median0.830.4550.513-1.349