A study published in the British Journal of Surgery has identified substantial variation in rates of surgical postponements across NHS trusts in England and suggests how streamlining perioperative pathways can ensure better care for patients and support the NHS’s recovery of elective surgical services.
Postponement of surgery in the days and weeks leading up to the planned date (as distinct from cancellations on the day) can be upsetting for patients and inefficient for the NHS, as many surgical theatre slots remain unfilled following postponement and there is often a need to repeat pre-operative assessments and tests when surgery is rescheduled. This causes increased administrative burden for both operational and clinical teams.
The new study – entitled Variation in surgery postponement rates in the NHS in England – details how the authors* collected data on surgical postponements following preoperative assessment at 16 NHS trusts across England during a two-week period in March 2024. A total of 8,000 case notes were reviewed.
The average postponement rate was 7% across the cohort, but postponement rates varied from 1% to 32% for individual trusts. Half of all routine patients waited over 90 days and a quarter of patients waited almost 200 days from being added to a patient tracking list to preoperative assessment. Of the 342 routine patients, 86% had postponements for medical rather than pathway or process reasons; many of these postponements were likely to be avoidable with appropriate timing and management of pre-operative assessment.
The authors conclude that minimising postponements and improving preoperative assessment efficiency by implementing earlier risk stratification and optimisation pathways following the decision for surgery should be part of wider initiatives to streamline perioperative pathways. Such work can offer better care for patients and can support the NHS’s recovery of elective surgical services.
The work has now been extended to an audit of all NHS trusts in England, to look at both postponements and on-the-day cancellations, run in conjunction with the National Institute for Health and Care Research (NIHR). The audit took place in a week in November with the final data entry by 9th December 2024, and will be published in 2025.
*The study was carried out by:
- Emma McCone, GIRFT national lead for preoperative assessment
- Chris Snowden, GIRFT national clinical lead for anaesthesia and perioperative medicine
- Michael Swart, GIRFT national clinical lead for anaesthesia and perioperative medicine
- Professor Tim Briggs, GIRFT chair and NHS England’s National Director for Clinical Improvement and Elective Recovery
- William Gray: GIRFT’s academic content lead
