J. of Ambulatory Surgery 12 (2005) 57–60 Cancellations in day-case ENT surgery G. Carter Singh a,* , Riaz Agha a , David R. Roberts b a Guy’s, King’s & St. Thomas’ School of Medicine, London, UK b The ENT & Audiology Department, 3rd Floor Thomas Guy House, Guy’s Hospital, SE1 9RT, UK Received 26 February 2005; accepted 18 May 2005 Available online 10 August 2005 Abstract Introduction: In excess of two million operations are performed in a day-case/ambulatory setting in the United Kingdom each year. Cancel- lations in elective surgery cost the National Health Service (NHS) over £265 million per year. Methodology: This is a retrospective study in which the total number of elective ENT operations performed at The Guy’s & St. Thomas’ NHS Trust in a 6-month period were investigated for a range of demographic factors including, age, gender and ethnicity with regards to their relationship to operative cancellation rates. Results: The overall cancellation rate was 19.9% (21.7% for females and 18.5% for males—this was statistically signiﬁcant (p < 0.001)). There was a statistically signiﬁcant difference between the three age groups (p < 0.001). There was a signiﬁcant difference between the two commonest reasons for cancellation—“patient failed to arrive” and “patient unﬁt”. The cancellation rate for day-case operations was 11.4% and this was signiﬁcantly lower than that for elective operations at 21.6% with (p < 0.001). The cancellation rates were 16.0% for Caucasians, 23.7% for blacks and 22.6% for Asians. There was a signiﬁcant increase in cancellations during the winter months. Discussion/recommendations: Attention should be paid to subgroups at higher risk of operative cancellation (0 to 20-year olds, ethnic minorities, non-day case) especially in the winter months. The reason(s) for cancellation should be clearly recorded in the patient’s notes. Medical staff at all levels should be given appropriate training as to the clinical signiﬁcance of good note-keeping and its enforcement. The coding system for the classiﬁcation of operative cancellations should be extensive and descriptive so as to include a broad range of categories. © 2005 Elsevier B.V. All rights reserved. Keywords: Cancellation; Demograhic; Day-surgery; Ambulatory surgery; ENT 1. Introduction Day-case surgery has rapidly expanded as a cost-effective and resource-conserving surgical intervention to the point that well in excess of two million operations are performed in a day-case/ambulatory setting in the United Kingdom alone each year. Cancellations in elective surgery can cost the National Health Service (NHS) up to £266 million per year [1,2]. Studies have shown that 5% of patients fail to attend when summoned from a waiting list for routine ENT surgery [3]. One of the most common reasons cited for the wastage of theatre time is failure of patients on waiting lists to attend * Corresponding author. Present address: 3 Bakewell Close, Mickleover, Derby DE3 9JS, UK. Tel.: +44 7861685801. E-mail address: doctorsingh@doctors.org.uk (G.C. Singh). for operations when sent for [4,5]. This is not the sole rea- son for cancelled operations and previous studies have failed to investigate the plethora of alternative demographic factors that may play a signiﬁcant role. The literature shows that theatres are only used for 50–60% of the time for which they are available [6]. This suggests that valuable theatre time is being wasted and waiting lists are unnecessarily prolonged due to cancelled operations. Pre-admission clinics can improve efﬁciency and alleviate the ﬁnancial burden of cancelled operations [7], although this view has not been unanimously accepted [8]. Whether the patients are assessed 24 h prior to the operation or 30 days before, makes no signiﬁcant difference to the cancellation rate [9]. Attention to a multitude of factors involved with patient operative care including pre-operative screening, lab testing, compliance with fasting guidelines 0966-6532/$ – see front matter © 2005 Elsevier B.V. All rights reserved. doi:10.1016/j.ambsur.2005.05.002