[2026-08-13] Incidence, Reasons and Factors Associated With Day-of-Surgery Cancellations at a Secondary Care Hospital Perspective: A Retrospective Cross-Sectional Study

Abstract

Background: Day-of-surgery cancellations (DOSC) remain a global concern, with a pooled incidence of 18%, exceeding the recommended < 5% benchmark. In Thailand, reported hospital-specific DOSC rates vary widely, ranging from 2% to 18.7%. The evidence from regional secondary care centers is limited, as exemplified by Chaophrayayommarat Hospital (CYH) in Suphan Buri province. Objectives: To investigate the incidence, reasons, and factors associated with DOSC at CYH. Methods: This retrospective cross-sectional study was conducted. Data were obtained from 7115 scheduled elective surgical cases from 1 January 2025 to 30 June 2025. DOSC were classified into patient-related, surgeon-related, hospital/system-related and anesthesia-related factors. Variables available in the hospital database, including age, gender, weight, and surgical department, were evaluated for their association with DOSC using multivariable logistic regression analysis. Results: DOSC incidence was 3.3% (95% CI, 3.0%-4.0%). Patient-related (51.9%%) and surgeon-related (29.5%) factors were predominant. Of patients deemed ineligible for surgery, 20.6% were already in the operating room. Compared with General Surgery, higher adjusted odds ratios (aORs) of DOSC were observed in Medicine (50%; aOR, 22.61; 95% CI, 3.10-164.73; P = .002), Vascular Surgery (39.5%; aOR, 15.19; 95% CI, 7.38-31.23; P < .001), Neurosurgery (7.9%; aOR, 1.95; 95% CI, 1.09-3.50; P = .02), Plastic and Reconstructive Surgery (6.7%; aOR, 1.71; 95% CI, 0.84-3.48; P = .14), Orthopedic Surgery (6.3%; aOR, 1.56; 95% CI, 1.05-2.32; P = .03), and Pediatric Surgery (6.0%; aOR, 1.44; 95% CI, 0.60-3.49; P = .42). Conclusions: Overall DOSC rate was below the recommended benchmark, variation across surgical departments persisted. Patient-related medical issues and surgeon-related factors predominated, with late identification of ineligible patients contributing to DOSC. Differences in DOSC occurrence were observed across surgical departments. Further prospective studies incorporating patient-level and system-level variables are needed to identify potentially modifiable predictors of DOSC.