Abstract
Introduction
Unexpected cancellation of scheduled total joint arthroplasty (TJA) procedures create patient distress and are disruptive to the clinical team. The purpose of this study was to identify the etiology of cancellation for scheduled TJA and to determine the subsequent fate of those patients.
Methods
A consecutive series of 11670 primary THA and TKA patients at a single institution was reviewed from January 2013 through March 2017. All patients who were scheduled for a primary THA or TKA and subsequently cancelled were identified. The etiology of cancellation and time to rescheduling were recorded. Univariate analysis and cox regression models were performed.
Results
505 (4.3%) of the 11,670 scheduled patients had their surgery cancelled. 209 (42%) were due to medical reasons and 173 (34%) were secondary to patient preference. 391 patients (77%) eventually underwent their procedure at a mean delay of 165 days (19 –1908 days). The most common medical reasons for cancellation included cardiac disease (n=44, 21%), hyperglycemia (n=32, 15%) and dental infections (n=24, 11%). Only 53 (25%) patients cancelled for a medical reason underwent further diagnostic or therapeutic intervention for their medical condition. When compared to patient driven cancellations, those cancelled for medical reasons had a higher mean CCI (0.82 vs. 0.39, p<0.001), were cancelled closer to the scheduled surgery date (8.55 vs 18.1 days, p<0.001), had similar time periods between cancellation and rescheduling (159 vs 177 days, p=0.445) and were more likely to eventually undergo surgery (86% vs. 73%, p=0.004).
Conclusion
TJA surgeries are most often cancelled due to a medical concern. Yet, only a minority of these patients undergo intervention for that medical condition. Cancelled patients have their surgery delayed, on average, over 5 months. To minimize the risk of cancellation, healthcare providers should consider early referral of medically complex patients to the patient's primary care physician.
