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Hänninen-Khoda L, Koljonen V, Ylä-Kotola T. Late cancelations in plastic and reconstructive surgery: A departmental study. Scand J Surg 2023; 112:269-271. [PMID: 37752862 DOI: 10.1177/14574969231201791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Affiliation(s)
- Liisa Hänninen-Khoda
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Virve Koljonen
- Professor Department of Plastic Surgery Park Hospital University of Helsinki and Helsinki University Hospital P.O.B 281 00029 Helsinki Finland
| | - Tuija Ylä-Kotola
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Sukwana A, Mrara B, Oladimeji O. Prevalence and Causes of Elective Surgical Cancellations: Findings from a Rural Tertiary Hospital in the Eastern Cape, South Africa. Healthcare (Basel) 2023; 11:healthcare11020270. [PMID: 36673638 PMCID: PMC9859182 DOI: 10.3390/healthcare11020270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/06/2023] [Accepted: 01/13/2023] [Indexed: 01/17/2023] Open
Abstract
Background: Cancellations of elective surgeries adversely affect the patient, hospital staff, facility, and health system. Cancellations potentially result in hospital financial losses, theatre inefficiency, and substandard patient care. A common benchmark for the cancellation rate of elective surgeries is less than five percent, and most operating rooms fall short of this standard. There is a paucity of data on the rates and causes of elective surgical cancellations in rural, resource-limited settings. This study aimed to determine the prevalence of elective surgery cancellations, the causes for such cancellations, and the surgical disciplines most affected at Nelson Mandela Academic Hospital (NMAH). Methodology: This was an observational, descriptive, cross-sectional review of operating theatre records from January 2019 to July 2019. The prevalence and main causes of elective case cancellations were determined. The causes were classified, and the most affected surgical departments and patient characteristics were identified. Results: The prevalence of elective surgical case cancellations was 14.4% in our hospital, higher than the international benchmark of 5%. Patient-, facility-, and surgical-related factors were the leading causes of cancellations, and avoidable cancellations were mostly surgical- and anaesthetic-related. Ophthalmology was the most affected, followed by gynaecology and general surgery, with plastic surgery being the least affected. The most common patient-related factors were nonattendance and uncontrolled medical conditions, while overbooking was the most common surgical reason. Abnormal investigatory results and unfit status were the most common anaesthetic reasons. Facility-related issues included the lack of theatre time, equipment scarcity or malfunction, and staff unavailability. Most cancellations were unavoidable, but with careful planning, could be avoided. Conclusion and recommendations: This study identified challenges with theatre efficiency in a rural, resource-limited setting that call for the cooperation of multidisciplinary teams of surgeons, anaesthetists, nursing staff, and health care policymakers.
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Affiliation(s)
- Abongile Sukwana
- Anaesthesiology and Critical Care, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5099, South Africa
| | - Busisiwe Mrara
- Anaesthesiology and Critical Care, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5099, South Africa
- Correspondence:
| | - Olanrewaju Oladimeji
- Department of Public Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5099, South Africa
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Yokoyama R, Inokuchi R, Shimada K, Ueda H, Tanaka M, Tamiya N. Impact of COVID-19 on pediatric surgery cancellations: A retrospective study. Pediatr Int 2023; 65:e15662. [PMID: 38108148 DOI: 10.1111/ped.15662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 08/11/2023] [Accepted: 08/20/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Prevalence trends and reasons for pediatric surgery cancellation in Japan during the coronavirus disease 2019 (COVID-19) pandemic have not previously been reported. This study aimed to compare the prevalence and reasons for cancellation of pediatric surgeries in Japan before and during the COVID-19 pandemic. METHODS This single-center retrospective cohort study reviewed the reasons for surgery cancellations scheduled for patients aged <18 years between the prepandemic period (September 2017-December 2019) and the COVID-19 pandemic period (January 2020-April 2022). The cancellation reasons were classified into four major categories: medical, surgical, patient-related, and administrative. RESULTS Of the 3395 and 3455 surgeries scheduled before and during the COVID-19 pandemic, 305 (9.0%) and 319 (9.2%) surgeries were canceled (p = 0.737), respectively. The proportion of cancellations due to infections or fever in medical reasons decreased from 67.9% to 56.1% (p = 0.003) and that due to patient-related reasons increased from 6.6% to 15.1% (p = 0.001). Further, the proportion of cancellations due to staff shortages in staff administrative reasons increased from 0.3% to 3.1% (p = 0.011). There was no significant difference in the proportion of surgeries canceled due to surgical reasons between the two periods. CONCLUSIONS The proportion of cancellations due to infections or fever decreased during the COVID-19 pandemic, while that due to staff shortages increased. Infection prevention is an important measure to address the staff shortages. Implementation of national or regional policies and additional strategic interventions may be required to prepare for disasters like the COVID-19 pandemic.
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Affiliation(s)
- Ryota Yokoyama
- Department of Health Services Research, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
- Department of Anesthesiology, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Ryota Inokuchi
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kensuke Shimada
- Department of Health Services Research, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
| | - Hiroshi Ueda
- Department of Anesthesiology, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Makoto Tanaka
- Department of Anesthesiology, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Nanako Tamiya
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
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Jiang W, Carvalho D. COVID-19 effects on operating room cancellations at a pediatric tertiary care hospital: A retrospective cohort study. Ann Med Surg (Lond) 2022; 81:104427. [PMID: 36035597 PMCID: PMC9392554 DOI: 10.1016/j.amsu.2022.104427] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/07/2022] [Accepted: 08/12/2022] [Indexed: 11/15/2022] Open
Abstract
Background Same-day surgery cancellation results in decreased operating room (OR) utilization, reduced productivity, and inconvenience for patients. We aim to assess the cancellation rates of elective surgeries, identify common causes, and evaluate changes due to the COVID pandemic. Methods A retrospective cohort study was conducted identifying all same-day surgery cancellations at a tertiary pediatric academic hospital from 1/1/2015 to 12/31/2017 (pre-COVID) and from 4/1/2020 to 3/31/2021 (post-COVID). Statistical analysis was performed using generalized regression with cancellation as the dependent variable. Period, age, ethnicity, gender, preferred language, and insurance were independent variables. Results There were 55465 scheduled cases (41670 before and 13795 after COVID), with 1508 cancellations (2.7%). Of those, 1247 (3.0%) were before COVID and 261 (1.9%) after COVID (p < .001). Of all cases, 56.7% (31475) were male, 55.1% (30595) were non-Hispanic/Latinx whites, 82.3% (45638) spoke English, and 45.5% (25237) had public insurance. The mean age was 8.5 years (SD = 6.03). The decrease in the probability of cancellation was most significant in patients with public insurance, < 1 year-of-age, Hispanic/Latinx who spoke Spanish (pre-pandemic = 4.9% [CI = 4.2%–5.8%]; pandemic = 2.8% [95% CI = 1.9%–4.0%]. Regardless of the period, Hispanic/Latinx patients and those with public insurance had higher rates of surgery cancellations (p < .001). Conclusion There was a significant decrease in same-day cancellations post-pandemic. We hypothesize that the required pre-operative COVID test helped to minimize same-day cancellations. Increased communication and education enhanced family engagement and was critical for improved OR metrics, including cancellation rates. Level of evidence level IV.
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Affiliation(s)
- Wen Jiang
- Department of Otolaryngology, University of California San Diego, San Diego, CA, USA
- Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Daniela Carvalho
- Department of Otolaryngology, University of California San Diego, San Diego, CA, USA
- Rady Children's Hospital San Diego, San Diego, CA, USA
- Corresponding author. 3020 Children's Way, MC 5024, San Diego, CA, 92123, USA.
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Kristoffersen EW, Opsal A, Tveit TO, Berg RC, Fossum M. Effectiveness of pre-anaesthetic assessment clinic: a systematic review of randomised and non-randomised prospective controlled studies. BMJ Open 2022; 12:e054206. [PMID: 35545393 PMCID: PMC9096538 DOI: 10.1136/bmjopen-2021-054206] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 04/15/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this systematic review was to examine the effectiveness of pre-anaesthesia assessment clinics (PACs) in improving the quality and safety of perioperative patient care. DESIGN Systematic review. DATA SOURCES The electronic databases CINAHL Plus with Full Text (EBSCOhost), Medline and Embase (OvidSP) were systematically searched on 11 September 2018 and updated on 3 February 2020 and 4 February 2021. ELIGIBILITY CRITERIA The inclusion criteria for this study were studies published in English or Scandinavian language and scientific original research that included randomised or non-randomised prospective controlled studies. Additionally, studies that reported the outcomes from a PAC consultation with the patient present were included. DATA EXTRACTION AND SYNTHESIS Titles, abstracts and full texts were screened by a team of three authors. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal checklist for quasi-experimental studies. Data extraction was performed by one author and checked by four other authors. Results were synthesised narratively owing to the heterogeneity of the included studies. RESULTS Seven prospective controlled studies on the effectiveness of PACs were included. Three studies reported a significant reduction in the length of hospital stay and two studies reported a significant reduction in cancellation of surgery for medical reasons when patients were seen in the PAC. In addition, the included studies presented mixed results regarding anxiety in patients. Most studies had a high risk of bias. CONCLUSION This systematic review demonstrated a reduction in the length of hospital stay and cancellation of surgery when the patients had been assessed in the PAC. There is a need for high-quality prospective studies to gain a deeper understanding of the effectiveness of PACs. PROSPERO REGISTRATION NUMBER CRD42019137724.
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Affiliation(s)
- Eirunn Wallevik Kristoffersen
- Department of Health and Nursing Science, University of Agder, Kristiansand/Grimstad, Norway
- Department of Anaesthesiology and Intensive Care, Sørlandet Hospital, Kristiansand, Norway
| | - Anne Opsal
- Department of Health and Nursing Science, University of Agder, Kristiansand/Grimstad, Norway
| | - Tor Oddbjørn Tveit
- Department of Health and Nursing Science, University of Agder, Kristiansand/Grimstad, Norway
- Department of Anaesthesiology and Intensive Care, Sørlandet Hospital, Kristiansand, Norway
- Department of Technology and e-Health, Sørlandet Hospital, Kristiansand, Norway
| | - Rigmor C Berg
- Divison for health services, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine, University of Tromsø, Tromsø, Norway
| | - Mariann Fossum
- Department of Health and Nursing Science, University of Agder, Kristiansand/Grimstad, Norway
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Pediatric Plastic Surgery Operating Room Block-Time Utilization: A Casualty of Illness. J Craniofac Surg 2022; 33:1303-1306. [PMID: 35142734 DOI: 10.1097/scs.0000000000008547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/21/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Optimizing operating room (OR) utilization is a critical component of health care system efficiency. The purpose of our study was to analyze the extent of OR cancellation and its effect on raw utilization of OR block time allotted to surgeons in the pediatric plastic surgery department. METHODS The authors retrospectively reviewed the cases of 4 plastic surgeons at a tertiary pediatric hospital between 2018 and 2019. Data collected included patient demographics, type of surgery, time of cancellation, reason for cancellation, length of surgery, and minutes of block time allotted to each surgeon per year. Percent of cases canceled, scheduled times lost, and block times lost were calculated. RESULTS Surgeons A, B, C, and D scheduled 170, 416, 305, and 474 cases, respectively. Overall, 7% of cases were canceled, 9.1% of scheduled time was lost, and a total of 5.1% of block time was lost due to cancellation. Patients of surgeon A and D were more likely to cancel due to reasons classified as "other," including causes such as failure of nil per os or a family's last-minute decision to forego elective surgery (33.3% and 37.2%, respectively), whereas patients of surgeon B and C were more likely to cancel due to illness (67.9% and 36.4%, respectively). CONCLUSIONS Cancellations negatively impact raw utilization times; if fewer cases are performed, allotted block times are redistributed. Communication with patients in the week prior to surgery may allow for earlier identification of likely cancellations. Future directions include exploring whether particular surgeon characteristics are linked to rate of cancellations.
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Kash N, Roopani RB, Leavitt M, Leavitt A. Exploring the Reasons and Financial Implications of Same-Day Cancellations of Hair Restoration Surgery: A Single-Center Retrospective Study. Dermatol Surg 2021; 47:1678-1680. [PMID: 34750304 DOI: 10.1097/dss.0000000000003272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Natalie Kash
- Department of Dermatology, Kansas City University-Graduate Medical Education Consortium/Advanced Dermatology and Cosmetic Surgery Orlando Dermatology Program, Maitland, Florida
| | - Rahil B Roopani
- Hair Restoration Surgery Fellowship Program, Leavitt Medical Associates, Maitland, Florida
| | - Matt Leavitt
- Department of Dermatology, Kansas City University-Graduate Medical Education Consortium/Advanced Dermatology and Cosmetic Surgery Orlando Dermatology Program, Maitland, Florida
- Advanced Dermatology and Cosmetic Surgery, Maitland, Florida
- College of Medicine, University of Central Florida, Orlando, Florida
- Bosley Medical Group, Maitland, Florida
| | - Adam Leavitt
- Department of Dermatology, The University of Michigan, Ann Arbor, Michigan
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Anderson-Bagga F, Fatehi M, Fogel J, Capria A. Predictors of Gynecologic Surgery Cancellations at a Teaching Hospital. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Frances Anderson-Bagga
- Department of Obstetrics and Gynecology, Nassau University Medical Center, East Meadow, New York, USA
| | - Mary Fatehi
- Department of Obstetrics and Gynecology, Nassau University Medical Center, East Meadow, New York, USA
| | - Joshua Fogel
- Department of Obstetrics and Gynecology, Nassau University Medical Center, East Meadow, New York, USA
- Department of Business Management, Brooklyn College of the City University of New York, Brooklyn, New York, USA
| | - Anthony Capria
- Department of Obstetrics and Gynecology, Nassau University Medical Center, East Meadow, New York, USA
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Ananthasekar S, Patel JJ, Patel NJ, Awad SK, Boyd CJ, King TW. The Content of US Plastic Surgery Private Practices' Websites. Ann Plast Surg 2021; 86:S578-S584. [PMID: 34100817 DOI: 10.1097/sap.0000000000002881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Connecting patients with healthcare providers continues to grow as the digital era evolves. A successful website has the power to influence patients on choosing a practice and provider. The objectives of this study were to characterize information provided on private practice websites of plastics surgeons in the United States and to assess the relationship among the websites based on the number of years that the physicians have been in practice. METHODS Newly board-certified plastic surgeons by the American Board of Plastic Surgery in 2005, 2010, and 2015 were identified. A Google search was conducted on all participants, and only those in private practice were included in this study. Each webpage was quantitatively and qualitatively assessed for the presence or absence of 23 criteria that were categorized as practice, physician, patient, or procedure information. χ2 was used for statistical analysis using Microsoft Excel (PSPP 1.2.0). A P value of less than 0.05 was considered statistically significant. RESULTS Most plastic surgeons in each cohort were currently in private practice. A total of 532 plastic surgery private practice websites were analyzed. The data points found on 100% of the websites were directions to the facility and the contact for any billing questions. Most websites provided information on the practice and its surgeons. The most common web-based data points included online consultations and links to their social media. Information on expenses incurred by patients, such as cancellation policies and consultation fees, was least commonly listed. CONCLUSIONS Our study shows that the number of years in practice is not associated with comprehensiveness of their website's content. This study provides insight into the content of plastic surgery private practices' websites in the United States in relation to the practice, the physician, the patient, and the procedures. This information may be useful for expanding and optimizing their websites. This has the potential to increase patient satisfaction and visibility of the practice. The success of these businesses is vital as the private sector in plastic surgery continues to grow.
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Krueger CA, Kozaily E, Gouda Z, Chisari E, Courtney PM, Austin MS. Canceled Total Joint Arthroplasty: Who, What, When, and Why? J Arthroplasty 2021; 36:857-862. [PMID: 33032875 DOI: 10.1016/j.arth.2020.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/21/2020] [Accepted: 09/03/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Unexpected cancelation of scheduled total joint arthroplasty (TJA) procedures creates patient distress and disruption for the clinical team. The purpose of this study is to identify the etiology and fate of cancelations for scheduled TJAs. METHODS A consecutive series of 11,670 patients at a single institution from 2013 to 2017 was reviewed in March 2020. All patients who were scheduled for a primary total hip arthroplasty or total knee arthroplasty and subsequently canceled were identified. The etiology of cancelation and time to rescheduling were recorded. RESULTS Of the 505 (4.3%) canceled patients, 209 (42%) were due to medical reasons. Three hundred ninety-one patients (77%) eventually underwent their procedure at a mean delay of 165 days (19-1908). Only 53 (25%) patients canceled for a medical reason underwent further diagnostic or therapeutic intervention for their medical condition. When compared to patient-driven cancelations, those canceled for medical reasons had a higher mean Charlson Comorbidity Index (0.82 vs 0.39, P < .001), were canceled closer to the scheduled surgery date (8.55 vs 18.1 days, P < .001), and were more likely to eventually undergo surgery (86% vs 73%, P = .004). CONCLUSION Canceled elective TJA surgeries are most often due to a medical concern, however only a minority of these patients undergo intervention for that medical condition. To minimize the risk of cancelation, healthcare providers may consider early referral of medically complex patients to the patient's primary care physician. After cancelation, patients should have a clearly defined path to return to the operative schedule to prevent further delays.
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Affiliation(s)
| | | | - Zane Gouda
- Sidney Kimmel Medial College, Thomas Jefferson University Hospital, Philadelphia, PA
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Abate SM, Chekole YA, Minaye SY, Basu B. Global prevalence and reasons for case cancellation on the intended day of surgery: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF SURGERY OPEN 2020; 26:55-63. [PMID: 34568611 PMCID: PMC7440086 DOI: 10.1016/j.ijso.2020.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/15/2020] [Accepted: 08/17/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cancellation of operation on the intended day of surgery affects the efficiency of Operation Room which incurs a significant financial loss for the patient, hospital, and health care cost of a country at large. This systematic and Meta-Analysis was intended to provide evidence on the global prevalence and determinants of case cancellation on the intended day of surgery. METHODS A comprehensive search was conducted in PubMed/Medline; Science direct and LILACS from January 2010 to May 2020 without language restriction. The Heterogeneity among the included studies was checked with forest plot, χ2 test, I2 test, and the p-values. All observational studies reporting prevalence and determinants were included. RESULTS A total of 1207 articles were identified from different databases with an initial search. Fort-eight articles were selected for evaluation after the successive screening. Thirty-three Articles with 306,635 participants were included. The Meta-Analysis revealed that the global prevalence of case cancellation on the intended day of surgery was 18% (95% CI: 16 to 20). The Meta-Analysis also showed that lack of operation theatre facility accounted for the major reason for cancellation followed by no attendant and change in medical condition. CONCLUSION The meta-analysis revealed that the prevalence of case cancellation was very high in low and middle-income countries and the majorities were avoidable which entails rigorous activities on operation theatre facilities, preoperative evaluation and preparation, patient and health care provider communications. REGISTRATION This Systematic Review and Meta-Analysis was registered in a research registry (researchregistry5746) available at https://www.researchregistry.com/browse-the-registry#home/.
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Affiliation(s)
- Semagn Mekonnen Abate
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Ethiopia
| | - Yigrem Ali Chekole
- Department of Psychiatry, College of Health Sciences and Medicine, Dilla University, Ethiopia
| | - Solomon Yimer Minaye
- Department of Psychiatry, College of Health Sciences and Medicine, Dilla University, Ethiopia
| | - Bivash Basu
- Department of Anesthesiology, College of Health Sciences, University of Calcutta, India
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