# Last-minute cancellation of elective lung cancer surgery is associated with poorer survival

## TL;DR

Last-minute cancellations of lung cancer surgery are linked to worse long-term survival, especially when cancellations are due to patient-related issues.

## Contribution

This study identifies a link between last-minute cancellations of lung cancer surgery and poorer survival, particularly for patient-related cancellations.

## Key findings

- 12% of lung cancer surgeries were cancelled last-minute, with 79% due to process-related and 21% to patient-related reasons.
- Patient-related cancellations were strongly associated with poorer 5-year survival compared to non-cancelled surgeries.
- Process-related cancellations had a less significant impact on survival than patient-related cancellations.

## Abstract

Previous studies have highlighted the negative impact on patients’ and relatives’ psychological status following last-minute cancellations (LMCs) [1] and its relationship with poorer prognosis [1–5].

Our objective was to assess the incidence and reason of last-minute cancellations before surgery for lung cancer and their association with outcomes.

Retrospective analysis on all consecutive patients booked for elective lung cancer surgery from January 2017 through December 2022 in a single centre. Last-minute cancellation: a cancellation occurring within the last 24 h from the planned operation. Cancellation categories: process-related and patient-related. The short-term and long-term outcomes of patients who experienced a last-minute cancellation were analysed.

197 patients of 1587 (12%) had a last-minute cancellation: 156 (79%) were process-related and 41 (21%) were patient-related. Three percent (5/156) of patients cancelled for process reasons did not receive surgery versus 39% (16/41) of those cancelled for patient-related reasons, P < 0.0001. The 90-day mortality rates of cancelled and non-cancelled patients were similar (4.6% vs 4.7%, P = 1). Five-year overall survival of patients with cancellation was 58% (95% confidence interval 49–66) vs 69% (95% confidence interval 66–71) of those without cancellations, P = 0.022. Among those who had a cancellation, the 5-year overall survival of those with process-related cancellations was 61% (52–60) vs 35% (14–58) of those with patient-related cancellations (adjusted P value for multiple comparisons = 0.14). Cox regression analysis showed that surgery cancellations within the last 24 h for patient-related (hazard ratio 1.87, 95% confidence interval 1.02–3.42, P = 0.043) reasons remained a factor associated with poorer overall survival after adjusting for clinical stage, type of operation and patient-related variables.

Implementing the patient’s preoperative clinical evaluation to reduce the occurrence of related last-minute cancellations might mitigate its negative impact on survival.