Analysis of Elective Surgical Cancellations Due to ICU Bed Unavailability

Abstract

Background: The cancellation of non-urgent surgical procedures due to the unavailability of Intensive Care Unit (ICU) beds remains a prominent issue that affects the healthcare system This study aims to investigate the extent of cancellations of non-urgent surgical procedures due to the unavailability of Intensive Care Unit (ICU) beds and to examine the associated clinical and operational implications for anesthesia and intensive care.

Methods: The retrospective study at the Military Instruction Hospital Mohammed V investigated non-urgent surgical cancellations due to ICU bed unavailability from March 2021 to April 2022. Inclusive criteria covered all non-urgent surgeries, excluding emergencies and patients under 18 with incomplete records. Data collection included patient demographics, clinical details, and ICU bed documentation. Trained personnel ensured consistency and confidentiality during data extraction. Statistical analyses, featuring descriptive statistics and logistic regression, assessed cancellation impacts on various patient populations and specialties. Thematic analysis provided insights into challenges associated with surgical scheduling and resource allocation, suggesting potential strategies for optimizing ICU capacity management,

Results: The study at Military Instruction Hospital Mohammed V in Rabat investigated 3023 scheduled surgeries from March 2021 to April 2022. Of these, 78 surgeries were canceled due to insufficient ICU beds, indicating a 2.5% prevalence. The median age of canceled surgery patients was 64, with a slight female predominance (56.4%). High-risk procedures constituted 52.5% of cancellations. Orthopedic surgeries had the highest cancellation rate (29.49%), followed by visceral (24.36%) and neurosurgery (19.23%). Gynecological surgeries exhibited a lower cancellation rate (7.69%). Variations across specialties suggest influences from procedure complexity or preoperative factors.

Conclusion: The study underscores the ongoing challenge of managing high-risk surgical patients in intensive care units in developed countries, emphasizing the complex interplay of pre-, intra-, and postoperative variables affecting patient outcomes. Concerns arise regarding the lack of effective triage systems, leading to potential underutilization or overutilization of intensive care resources. The findings stress the necessity for a more targeted approach to optimize care for vulnerable patients, highlighting the importance of further research to leverage available perioperative data for improved post-surgical management.

Keywords: Cancellation; Elective surgery; Postoperative Admission; Unavailability; ICU beds

Introduction

Surgical interventions require a coordinated effort from various medical professionals and resources, spanning the preoperative, intraoperative, and postoperative phases. The availability of these resources is crucial, especially for surgeries that may necessitate postoperative Intensive Care Unit (ICU) admission. However, the cancellation of scheduled surgeries due to a lack of ICU beds poses a significant challenge in modern healthcare systems.

This issue has far-reaching implications, including increased healthcare costs, compromised patient outcomes, and disruptions to surgical scheduling. Existing literature, including Poeran’s study [1] on surgical cancellations in New York during the COVID-19 pandemic, highlights a substantial link between cancellations and ICU bed availability. Sahraoui [2] have also explored late cancellations of elective surgeries, proposing solutions using constraint theory and emphasizing the role of capacity management in addressing bed crises.

This article aims to comprehensively investigate the cancellation of non-urgent surgeries due to ICU bed unavailability. Building upon previous studies, our objective is to quantify the frequency of cancellations, identify associated factors, and evaluate the direct impact on patients and healthcare structures. Through this exploration, we seek to contribute valuable insights into the challenges posed by the unavailability of ICU beds in the context of elective surgeries.

Methods

Study Design: This retrospective study focuses on the cancellation of non-urgent surgical procedures due to the unavailability of Intensive Care Unit (ICU) beds at the Surgical Block of the Mohammed V Military Teaching Hospital in Rabat. The method involves collecting and analyzing historical data from medical records and surgical databases over a one-year period from March 2021 to April 2022. The study protocol was approved by the Local Hospital Ethics and conducted according to the Declaration of Helsinki outlined. All non-urgent surgical interventions within the specified period at the Surgical Block were included, excluding urgent cases, patients under 18, and those with incomplete records. The data variables encompass patient demographics, clinical details, surgical severity, and documentation of ICU bed unavailability leading to cancellations.

Data Collection Process: Trained research personnel ensured consistency and accuracy during data extraction from electronic medical records and surgical databases. An exploitation form was utilized, emphasizing the secure handling of depersonalized data to maintain patient confidentiality.

Data Analysis: Descriptive statistical analysis summarized the collected data. Frequencies and percentages were calculated to discern the frequency of cancellations and reasons for ICU bed unavailability. Subgroup analyses were conducted to explore the impact on different patient populations and surgical specialties. This chapter serves as a foundation for the subsequent investigation into the dynamics of non-urgent surgical cancellations in relation to ICU bed availability.

Results

The overall prevalence of cancellations due to the unavailability of Intensive Care Unit (ICU) beds was 2.5% among the 3023 scheduled patients from March 2021 to April 2022, underscoring its impact on various demographic aspects, procedural complexities, and surgical specialties.

The median age of patients whose surgeries were canceled due to a lack of ICU bedswas 64 years, indicating a generally older population. This cancellation trend affected more females (56.4%) than males (43.6%), revealing a slight female predominance with a sex ratio (F/M) of 1.3. Regarding the ASA Physical Status classification, 68.7% of the canceled surgery patients were classified as ASA I or II, indicating better overall health. Meanwhile, 28.5% were ASA III (indicating moderate health), and 2.8% were ASA IV or V (indicating impaired overall health). The severity of the canceled interventions varied, with 3.5% categorized as minor, 10.6% as intermediate, 33.5% as major, and 52.5% deemed high-risk procedures.

These cancellations had a notable impact on diverse surgical specialties. Orthopedic Surgery was the most affected, constituting 29.49% of cancellations, possibly due to the complexity of certain orthopedic interventions or specific preoperative factors. Abdominal Surgery recorded a significant proportion of 24.36%, indicating possible underlying medical conditions in patients. Neurosurgery was impacted at 19.23%, highlighting the delicate nature of these interventions. Conversely, Gynecological Surgery had a relatively low cancellation rate of 7.69%, suggesting better planning or fewer preoperative complications. Specialties such as Urology, Thoracic surgery, and others displayed moderate cancellation rates, namely 8.97%, 3.85%, and 6.41%, respectively, suggesting effective case management or lower risk factors.

These results shed light on the significant repercussions of cancellations of non-urgent surgeries due to a lack of ICU beds, impacting diverse populations and specialties. This underscores the need for more targeted management to optimize care for vulnerable patients.

In the context of our study, it was crucial for us to understand whether patient characteristics differ between those whose surgery was canceled due to a lack of ICU beds and those who were admitted to the ICU after their procedure. This comparison can provide crucial insights for healthcare professionals and hospital planners to better manage ICU bed availability and optimize patient care. The following table presents a detailed analysis of patient characteristics in these two distinct groups, highlighting significant similarities and differences between them. This comparison will contribute to informing future decisions regarding surgical planning and medical resource management to ensure optimal patient care.

The table above presents the characteristics of two distinct groups of patients based on their postoperative ICU admission. Group 1 includes patients whose surgeries were canceled due to a lack of ICU beds, while Group 2 comprises those who were admitted to the ICU after their surgery.

Both groups of patients demonstrate every similar baseline characteristic, including age, gender, ASA status, severity of intervention, and surgical specialty. These similarities indicate that, from the perspective of patients' basic characteristics, there are no significant differences between patients whose surgeries were canceled due to a lack of ICU beds and those who were admitted to the ICU after their surgery. Other factors or criteria must beconsidered to understand the reasons for surgery cancellations and ICU admission.

Discussion

Incidence of Post-Operative Intensive Care Unit (ICU) Admissions

In the study involving 3023 scheduled surgeries, 176 patients were admitted to the ICU postoperatively, resulting in an incidence of 5.8%. This rate stands comparatively higher than those reported in studies conducted in India [3] and Nigeria [4]. drawing attention to the significant variability in postoperative ICU admissions across different regions. The study underscores the importance of comprehending and effectively managing the factors contributing to ICU admissions after surgery (Table 2).

  


    
Patient    Characteristics

    
Previously    Canceled due to Lack of ICU Beds (N=78)

    
Not Canceled due    to Lack of ICU Beds (N=176)

  

  


    
N

    
78

    
176

  

  


    
Age (Median [IQR])

    
64 [54–74]

    
63 [54–74]

  

  


    
Gender = Male (%)

    
43.6% (34)

    
43.75% (77)

  

  


    
ASA Physical Status (%)

    
 

    
 

  

  


    
I or II

    
68.7% (53)

    
67.04% (118)

  

  


    
III

    
28.5% (22)

    
28.4% (50)

  

  


    
IV or V

    
2.8% (3)

    
4.5% (8)

  

  


    
Severity of Intervention (%)

    
 

    
 

  

  


    
Minor

    
3.8% (3)

    
3.5% (6)

  

  


    
Intermediate

    
10.25% (8)

    
10.6% (19)

  

  


    
Major

    
33.3% (26)

    
33.5% (59)

  

  


    
High risk

    
52.5% (41)

    
52.5% (92)

  

  


    
Specialty (%)

    
 

    
 

  

  


    
Abdominqll Surgery

    
24.36% (19)

    
25% (44)

  

  


    
Gynecology

    
7.69% (6)

    
7.38% (13)

  

  


    
Neurosurgery

    
19.23% (15)

    
19.31% (34)

  

  


    
Orthopedic Surgery

    
29.49% (23)

    
29.54% (52)

  

  


    
Thoracic Surgery

    
3.85% (3)

    
3.40% (6)

  

  


    
Urology

    
8.97% (7)

    
9.09% (16)

  

  


    
Other Specialty

    
6.41% (5)

    
6.25% (11)

  

Table 1: Comparison of Patient Characteristics in 2 Distinct Groups Based on Postoperative ICU Admission.

  


    
Authors 

    
Country 

    
Year 

    
Scheduled    Surgeries 

    
Admitted    Intensive Care Unit 

    
Percentage 

  

  


    
Bhat [3] 

    
India 

    
2006 

    
13,170 

    
204 

    
1.54% 

  

  


    
Ejiro [4] 

    
Nigeria 

    
2012 

    
7,724 

    
257 

    
3.30% 

  

  


    
Patel [5] 

    
India 

    
2014 

    
5,284 

    
238 

    
4.50% 

  

  


    
Our Study 

    
Morocco 

    
2023 

    
3,023 

    
176 

    
5.80% 

  

Table 2: Prevalence of Planned ICU Admission in Post operative Elective Surgery.

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Citation: Nadir H, Choubhi M, El Jellouli W, Alioui M, Elkachani T, et al. Analysis of Elective Surgical Cancellations Due to ICU Bed Unavailability. Austin Crit Care J. 2024; 11(1): 1046.

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