Factors Contributing to Operating Room Cancellation Rates for Patients Undergoing Arteriovenous Access Procedures

Operating room cancellation rates, defined as cancellation ≤24 hours of planned surgery, have been reported to be as high as 14% to 17.4%. In the United Kingdom, this cancellation rate average is 8.1%. One large metropolitan hospital system in the United States has chosen 6% as a target mandatory cancellation rate. Procedures in the fields of vascular and transplant surgery fall well outside this benchmark, particularly ones involving arteriovenous access (AVA). PubMed was searched to determine the reported cancellation rates for patients undergoing AVA surgery. Interestingly, there were no clearly defined studies or published rates of AVA procedure cancellation in the English language literature. Using an operating room quality assurance database, we analyzed the 1-year cancellation rate of AVA procedures by Current Procedural Terminology (CPT) code. Analysis included the number of cases cancelled and the reasons stated for case cancellation. Among 191 cases booked, encompassing CPT codes 36,819, 36,821, 36,830, and 36,831, 88 (46%) were cancelled ≤24 hours. Cancellations by surgical type were 36,819 (55%), 36,821 (46%), 36,830 (43%), and 36,830 (25%). The reasons for cancellation were as follows: 44% attributed to practice conditions, including scheduling issues, insurance verification, and attending schedule; 31% based on patient factors; and 25% listed as lack of medical clearance. A cancellation rate of 14% is generally reported, and accepted, for elective general surgery cases. This percentage is largely attributed to patient comorbidities and the disease process. However, the cancellation rate for patients undergoing AVA procedures is notably higher, at 46%. We believe that by minimizing practice-related and preoperative assessment variables, the AVA cancellation rate can be reduced to a percentage closer to the 14% for elective general surgery.