Operational
Day-of-surgery cancellation
Also known as: DOSC, same-day cancellation, late cancellation
A day-of-surgery cancellation is a planned operation called off on the day it was scheduled, usually after the patient has arrived fasted. Most are preventable: the common causes are unmanaged medications, unoptimised comorbidity, unscreened risk such as sleep apnoea, and logistical failures — all of which are identifiable weeks earlier.
- Also called
- DOSC, late cancellation
- Common causes
- Medication management, unoptimised comorbidity, unscreened risk, logistics
- Typical cost
- Lost theatre time plus an unrecoverable slot
- Prevention window
- From booking to roughly one week before surgery
The four causes
Medication management not planned. The clearest case is the SGLT2 inhibitor class, where a withholding plan must be made days ahead. When the medication list comes from patient recall at a pre-op phone call, the drug is often described as “something for sugar” and the plan is never made.
Comorbidity not optimised. Poor glycaemic control, uncontrolled hypertension and anaemia are modifiable given a window. The window only exists if the problem is found while there is still time.
Risk not screened. Undiagnosed obstructive sleep apnoea is the standing example — it changes the anaesthetic plan and sometimes the location of care, but only if the questions were asked.
Logistics and consent. Fasting instructions misunderstood, no escort home, no discharge support. The cheapest to prevent and the most frustrating to lose a theatre slot to.
Why it is an information problem
In almost every case the fact that caused the cancellation existed weeks earlier. It simply had not reached the anaesthetist while there was still time to act on it. That is what makes cancellation rate responsive to when assessment happens rather than to how carefully it is done — moving the assessment to booking converts an unrecoverable cancellation into a manageable optimisation.