Summary

Analysis of the cost, timing, and reason of last-minute surgical cancelations reveals an inflection point at which filling the surgical time slots becomes more difficult.

Abstract

Introduction

Last-minute elective surgeries cancelation occurs for medical and non-medical reasons and can result in poor operating room utilization. According to existing literature, the average revenue of shoulder surgery is $16,568±$8,457. This study aimed to determine whether there was an inflection time point at which a cancelation becomes more costly. We hypothesized that cancelations became more costly when canceled within one week of the scheduled date and that failure to obtain medical clearance would be a common reason for non-elective cancelation.

Methods

A retrospective review of 1,695 consecutive scheduled surgeries at one surgery center for one orthopaedic shoulder surgeon was performed. Cancelations between January 1, 2022 to December 31, 2023 were recorded including the date and reason for cancelation for cancelations within 2 weeks of surgery. The rate and percentage of cancelations that were filled were analyzed based on the number of days before the scheduled surgery that the cancelation occurred: 0-7 days compared to 8-14 days before the scheduled surgery. Reasons for cancelation were categorized as elective or non-elective. Estimated revenue losses were calculated using the average revenue of shoulder surgery found in existing literature. Descriptive statistics were calculated, and significance was determined via Fisher’s Exact test and Linear Regression analysis.

Results

There were 164 total cancelations, with 96 occurring within 2 weeks of the scheduled surgery. The average cancelation time was 5.90±4.22 days before surgery. For surgeries canceled within 2 weeks, 60.4% of the timeslots (58/96) were filled. When surgeries were canceled within one week of surgery, 43.8% (28/64) of timeslots were filled, a significant reduction compared to cancelations that occurred 8-14 days prior where 93.4% (30/32) of timeslots were filled (p=0.000). Linear regression showed a statistically significant (p=0.01) linear relationship between fill rate per day and day of cancelation. For cancelations that occurred 0-7 days before surgery, the average fill rate per day was 46.2%. For cancelations occurring 8-14 days before surgery, the average fill rate per day was 83.7%. Cancelations were elective for 37.5% (36/96) of those canceled within 8-14 days of the scheduled date and for 34.4% (22/64) of those canceled within 0-7 days. The rate of elective and non-elective cancelations did not differ between the 1- and 2-week mark (p=0.739). Unfilled elective cancelations accounted for 7 cancelations, $115,976 in lost revenue. More specifically, non-elective cancelations related to lack of medical clearance contributed to 17.2% (11/64) of cancelations, and those occurring within 1 week were left unfilled accounted for $182,248. Approximately $629,584 of revenue was lost due to unfilled timeslots.

Conclusion

This data supports our hypothesis that there was an inflection point, observed at 7 days prior to the scheduled surgery, at which time there was a statistically significant decrease in the rate of filling available surgical timeslots. The inability to obtain timely medical clearances also led to a substantial loss of revenue highlighting potential system pathways for improving access and efficiency.