# Optimizing Preoperative Assessment Timing to Reduce Surgical Cancellations: A Quality Improvement Project

## TL;DR

Moving preoperative assessments to at least 24 hours before surgery significantly reduced cancellations and improved hospital efficiency.

## Contribution

Demonstrates that earlier preoperative assessments reduce cancellations and wasted resources in surgical settings.

## Key findings

- Postponement rates dropped from 6.1% to 3.0% when assessments were done 24 hours before surgery.
- Wasted bed days per 100 patients decreased from 20.1 to 6.8 with the new timing protocol.

## Abstract

Introduction

Elective surgery cancellations are a major cause of inefficiency in healthcare systems, leading to wasted operating theater time, increased costs, and longer waiting lists. Many cancellations are attributable to inadequate preoperative assessment or incomplete optimization, especially when assessments are performed immediately before surgery. Preoperative assessment clinics allow timely identification and management of comorbidities, ensuring patients are medically optimized and required investigations are complete before the day of surgery. This project aimed to evaluate whether introducing earlier preoperative assessments could reduce cancellations for elective surgeries.

Methods

A quality improvement project was conducted at a public sector District Headquarters Hospital in Punjab, Pakistan. In cycle 1 (November 2021-January 2022), preoperative assessments were performed ≤1 hour before surgery. In cycle 2 (December 2022-February 2023), assessments were conducted ≥24 hours before surgery. Data on elective surgical cases (orthopedics, general surgery, and ENT) were collected from anesthesia postponement logs. The primary outcome was the rate of postponements due to inadequate optimization or incomplete laboratory work-up, and wasted bed days per 100 patients. Chi-squared testing was employed, with p < 0.05 considered statistically significant.

Results

A total of 1,884 patients were included across the two cycles. During cycle 1, 1,129 cases were assessed, while in cycle 2, a total of 755 cases were evaluated. Sixty-nine patients (6.1%) were postponed during the time frame for cycle 1. In contrast, 23 patients (3.0%) experienced delays to theaters during cycle 2. This represented a relative risk reduction of 50%, with an absolute risk reduction of 3.07%, which was found to be statistically significant (p = 0.02). Wasted bed days per 100 patients decreased from 20.1 to 6.8.

Conclusion

Shifting preoperative assessments to at least 24 hours before surgery halved avoidable cancellations, reduced wasted bed days, and improved operating theater efficiency. This low-cost intervention is especially relevant for resource-limited health systems where theater efficiency and bed availability are critical.