Surgical ProcedurePostponementNCT05352984
Postponement Rate of Elective Surgical Procedures
An observational study of Surgical Procedure, run by Hayatabad Medical Complex at 1 site in Pakistan.
Trial summary
Postponement of elective surgical procedures is a major issue in health care facilities. It increases burden on hospitals and healthcare systems as well as misery of the patients and their family members. Patient's stay in the hospitals is prolonged. Read more about this study
- Who is it for?
- Ages 15 years and older
- Conditions the study is for
- Surgical Procedure
- How many people
- 1,221 participants
- Where
- 1 sitePakistan
- Study dates
- 19 May 2022to 15 Feb 2023
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 15 years and older
- All sexes
- Child, Adult, Older adult
Study population: All inpatients admitted in surgical departments of three tertiary care hospitals[ MTI-(HMC, KTH,LRH)], Peshawar, Pakistan and scheduled for elective general surgical procedures.
Who may be able to join
- All inpatients of any age and either sex admitted in general surgery departments, scheduled for elective surgeries including laparoscopic surgeries, who arrive or are brought to operation theatre for general surgeries as elective cases.
Who cannot join
- All outdoor patients.
- Indoor cases of cardiac, cardiovascular, obstetrics and gynecology, neurosurgery, orthopedics, pediatrics or transplant surgeries or other surgeries considered as specialized surgeries.
- Emergency surgeries.
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Risk Factors Assessment and Postponement Rate of Elective Surgical Procedures in Tertiary Care Public Sector Hospitals, Peshawar, Khyber Pakhtunkhwa, Pakistan-A Multicenter Cross-sectional Study
Postponement of elective surgical procedures is a major issue in health care facilities. It increases burden on hospitals and healthcare systems as well as misery of the patients and their family members. Patient's stay in the hospitals is prolonged. Hospitals and patients resources are wasted and their expenses are increased. The rate of postponement is different in different regions. It is estimated to be in between 9 to 44 %. Reason may be organizational or medical. Elective procedures are cancelled due to insufficient OT timings, non-availability of; anesthetists, blood or beds in ICU, change of plan and medical reasons like respiratory infections, cardiac problems, hypertension and uncontrolled diabetes. Tertiary care hospitals in Peshawar, Khyber Pakhtunkhwa, Pakistan are overburdened and patients on OT list are frequently postponed. Operating room timings has been increased to overcome the issue but no recent data is available regarding actual postponement rate and possible causes in this region. The need is felt to assess the problem and suggest recommendations to decrease patients' sufferings and improve hospital workings.
Read the detailed description
Standardized surgical health care and its availability to every person in a community should the objective of a good health system but this is abstruse to complete especially in low and middle income countries. One reason for failure to complete this objective is postponement in elective surgical procedures. It increases burden on hospitals/ healthcare systems as well as misery of the patients and their family members. Patient's stay in the hospitals is prolonged. Hospitals and patients resources are wasted and their expenses are increased. Hospital resources like operation theatre (OT) are underutilized. Surgeons, nursing and other support staff's time is used worthlessly. Patients and attendants face economic and psychological stress. They bear extra financial burden due to stay in hospitals as well as leaves from work. They face more anxiety (42.1 %) and depressive disorders (26.3 %). Patient's health and outcome may deteriorate especially in cardiac, thoracic and cancer patients or in severe category or moribund patients waiting for their surgery.
Pakistan's health care system is based on public and private sector. Public sector health setups provides most facilities free of cost to the community. It is based on primary, secondary and tertiary health care setups. But they are not well integrated and proper referral system to secondary and tertiary health care is weak. Patients are unduly referred to tertiary care hospitals in more than their expected strengths by private clinics as well as by primary and secondary health care setups . Also because of our weak primary and secondary care system, patients coming to tertiary care setups are not aware of their comorbidities like Hypertension, diabetes, ischemic heart diseases, endocrine and respiratory diseases. We also receive fair number of referred patients from our neighboring country; Afghanistan. Some patients admitted for surgical procedures are postponed and are rescheduled for procedures in later dates, thus putting additional burden upon already overburdened system. The rate of postponement is different in different regions. It is estimated to be in between 9 to 44 %. Reason may be organizational or medical. Elective procedures are cancelled due to insufficient OT timings, non-availability of; anesthetists, blood or beds in ICU, change of plan and medical reasons like respiratory infections, cardiac problems, hypertension and uncontrolled diabetes. Cardiac surgeries, cancer surgeries, cholecystectomies, pediatric surgeries and thoracic surgeries are commonly postponed. In an older study done in 2007 in Abbotabad, Khyber Pakhtunkhwa, Pakistan, the postponement rate was 25 %. Elective procedures were cancelled due to shortage of time (36 %), beds (16.2 %), anesthetists (5.8 %) and medical reasons (31%) . Tertiary care hospitals in Peshawar, Khyber Pakhtunkhwa, Pakistan has increased the OR duration from 06 hours to 08 hours and so it is needed to know the new prevalence of cancellation rate of elective procedures and its causes adversely affecting the patients and hospital.
Rationale of the study: Tertiary care hospitals in Peshawar, Khyber Pakhtunkhwa are overburdened and patients on OT list are frequently postponed. Operating room timings has been increased but no recent data is available regarding actual postponement rate and possible causes in this region. The need is felt to assess the problem and suggest recommendations to decrease patients' sufferings and improve hospital workings.
Objectives: To assess the risk factors and postponement rate of elective surgical procedures on the same day of surgery in public sector tertiary care hospitals in Peshawar, Khyber Pakhtunkhwa, Pakistan.
Postponement is defined as cancellation of scheduled elective procedure on the day of operation.
- Conditions
- Surgical Procedure
- Keywords
- Postponement, Cancellation, Elective
What is being measured
The primary outcome is the main question the study is designed to answer.
Postponement rate of elective surgical procedures
Postponement/ cancellation rate of elective surgical procedures on the same day of surgery will be calculated.
Postponement rate= Total number of elective procedures cancelled / Total number of general surgeries performed in the defined time period * 100
Measured: Eight hours
Secondary outcomes (1)
Risk factors assessment of postponement
Risk factors for postponement of elective surgical procedures on the same day of surgery will be assessed for presence or absence though a questionnaire.
Measured: Eight hours
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted29 Apr 2022
- Study start19 May 2022
- Primary completion19 Aug 2022
- Study completion15 Feb 2023
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (9)Papers the sponsor has linked to this study.
- Other trials for Surgical ProcedureStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 1,221 participants (actual)
Sponsor and investigators
- Lead sponsor
- Hayatabad Medical Complex
- Sponsor type
- Other government
- Responsible party
- Principal investigator, Rahman Ullah Jan, Hayatabad Medical Complex
- Investigators
- Rahman U Jan, Principal investigator, Hayatabad Medical Complex
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05352984
- Sponsor's protocol ID
- 616/HEC/B&PSC/2022
- Acronym
- Postponement
- Status last verified
- Jul 2023
- First submitted
- 25 Apr 2022
- Last updated
- 14 Jul 2023
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: Data including clinical and demographic characteristics, not affecting patient's confidentiality, will be shared.
Publications
Meara JG, Leather AJ, Hagander L, Alkire BC, Alonso N, Ameh EA, Bickler SW, Conteh L, Dare AJ, Davies J, Merisier ED, El-Halabi S, Farmer PE, Gawande A, Gillies R, Greenberg SL, Grimes CE, Gruen RL, Ismail EA, Kamara TB, Lavy C, Lundeg G, Mkandawire NC, Raykar NP, Riesel JN, Rodas E, Rose J, Roy N, Shrime MG, Sullivan R, Verguet S, Watters D, Weiser TG, Wilson IH, Yamey G, Yip W. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015 Aug 8;386(9993):569-624. doi: 10.1016/S0140-6736(15)60160-X. Epub 2015 Apr 26. No abstract available.
PubMed 25924834Abate 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. Int J Surg Open. 2020;26:55-63. doi: 10.1016/j.ijso.2020.08.006. Epub 2020 Aug 20.
PubMed 34568611O'Rielly C, Ng-Kamstra J, Kania-Richmond A, Dort J, White J, Robert J, Brindle M, Sauro K. Surgery and COVID-19: a rapid scoping review of the impact of the first wave of COVID-19 on surgical services. BMJ Open. 2021 Jun 15;11(6):e043966. doi: 10.1136/bmjopen-2020-043966.
PubMed 34130956Tagarakis GI, Voucharas C, Simopoulos V, Karangelis D, Daskalopoulos ME, Parisis C, Tsantilas A, Sataitidis I, Lampoura S, Vretzakis G, Tsilimingas NB. Why are thoracic operations postponed? J Cardiothorac Surg. 2012 Apr 11;7:31. doi: 10.1186/1749-8090-7-31.
PubMed 22494485Kurji Z, Premani ZS, Mithani Y. Analysis Of The Health Care System Of Pakistan: Lessons Learnt And Way Forward. J Ayub Med Coll Abbottabad. 2016 Jul-Sep;28(3):601-604.
PubMed 28712245Sommer JL, Jacobsohn E, El-Gabalawy R. Impacts of elective surgical cancellations and postponements in Canada. Can J Anaesth. 2021 Mar;68(3):315-323. doi: 10.1007/s12630-020-01824-z. Epub 2020 Oct 21.
PubMed 33085061marymarcus. CAUSES OF POSTPONEMENT OF ELECTIVE SURGERY IN MAYO HOSPITAL LAHORE [PDF] [Internet]. Presentica. 2020 [cited 2021 Dec 27]. Available from: https://www.presentica.com/doc/10371391/causes-of-postponement-of-elective-surgery-in-mayo-hospital-lahore
Bathla S, Mohta A, Gupta A, Kamal G. Cancellation of elective cases in pediatric surgery: An audit. J Indian Assoc Pediatr Surg. 2010 Jul;15(3):90-2. doi: 10.4103/0971-9261.71748.
PubMed 21124662Zafar A, Mufti TS, Griffin S, Ahmed S, Ansari JA. Cancelled elective general surgical operations in Ayub Teaching Hospital. J Ayub Med Coll Abbottabad. 2007 Jul-Sep;19(3):64-6.
PubMed 18444594
Study at a glance
From the registry record, last updated by the sponsor on 14 Jul 2023. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Risk Factors Assessment and Postponement Rate of Elective Surgical Procedures in Tertiary Care Public Sector Hospitals, Peshawar, Khyber Pakhtunkhwa, Pakistan-A Multicenter Cross-sectional Study
- ClinicalTrials.gov ID
- NCT05352984
- Acronym / sponsor ID
- Postponement / 616/HEC/B&PSC/2022
- Conditions
- Surgical Procedure
- Keywords
- Postponement, Cancellation, Elective
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 1,221 participants (actual)
- Lead sponsor
- Hayatabad Medical ComplexOther government
- Study start
- 19 May 2022 (actual)
- Primary completion
- 19 Aug 2022 (actual)
- Study completion
- 15 Feb 2023 (actual)
- First posted
- 29 Apr 2022 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Postponement of elective surgical procedures is a major issue in health care facilities. It increases burden on hospitals and healthcare systems as well as misery of the patients and their family members. Patient's stay in the hospitals is prolonged. Hospitals and patients resources are wasted and their expenses are increased. The rate of postponement is different in different regions. It is estimated to be in between 9 to 44 %. Reason may be organizational or medical. Elective procedures are cancelled due to insufficient OT timings, non-availability of; anesthetists, blood or beds in ICU, change of plan and medical reasons like respiratory infections, cardiac problems, hypertension and uncontrolled diabetes. Tertiary care hospitals in Peshawar, Khyber Pakhtunkhwa, Pakistan are overburdened and patients on OT list are frequently postponed. Operating room timings has been increased to overcome the issue but no recent data is available regarding actual postponement rate and possible causes in this region. The need is felt to assess the problem and suggest recommendations to decrease patients' sufferings and improve hospital workings.
Detailed description
Standardized surgical health care and its availability to every person in a community should the objective of a good health system but this is abstruse to complete especially in low and middle income countries. One reason for failure to complete this objective is postponement in elective surgical procedures. It increases burden on hospitals/ healthcare systems as well as misery of the patients and their family members. Patient's stay in the hospitals is prolonged. Hospitals and patients resources are wasted and their expenses are increased. Hospital resources like operation theatre (OT) are underutilized. Surgeons, nursing and other support staff's time is used worthlessly. Patients and attendants face economic and psychological stress. They bear extra financial burden due to stay in hospitals as well as leaves from work. They face more anxiety (42.1 %) and depressive disorders (26.3 %). Patient's health and outcome may deteriorate especially in cardiac, thoracic and cancer patients or in severe category or moribund patients waiting for their surgery.
Pakistan's health care system is based on public and private sector. Public sector health setups provides most facilities free of cost to the community. It is based on primary, secondary and tertiary health care setups. But they are not well integrated and proper referral system to secondary and tertiary health care is weak. Patients are unduly referred to tertiary care hospitals in more than their expected strengths by private clinics as well as by primary and secondary health care setups . Also because of our weak primary and secondary care system, patients coming to tertiary care setups are not aware of their comorbidities like Hypertension, diabetes, ischemic heart diseases, endocrine and respiratory diseases. We also receive fair number of referred patients from our neighboring country; Afghanistan. Some patients admitted for surgical procedures are postponed and are rescheduled for procedures in later dates, thus putting additional burden upon already overburdened system. The rate of postponement is different in different regions. It is estimated to be in between 9 to 44 %. Reason may be organizational or medical. Elective procedures are cancelled due to insufficient OT timings, non-availability of; anesthetists, blood or beds in ICU, change of plan and medical reasons like respiratory infections, cardiac problems, hypertension and uncontrolled diabetes. Cardiac surgeries, cancer surgeries, cholecystectomies, pediatric surgeries and thoracic surgeries are commonly postponed. In an older study done in 2007 in Abbotabad, Khyber Pakhtunkhwa, Pakistan, the postponement rate was 25 %. Elective procedures were cancelled due to shortage of time (36 %), beds (16.2 %), anesthetists (5.8 %) and medical reasons (31%) . Tertiary care hospitals in Peshawar, Khyber Pakhtunkhwa, Pakistan has increased the OR duration from 06 hours to 08 hours and so it is needed to know the new prevalence of cancellation rate of elective procedures and its causes adversely affecting the patients and hospital.
Rationale of the study: Tertiary care hospitals in Peshawar, Khyber Pakhtunkhwa are overburdened and patients on OT list are frequently postponed. Operating room timings has been increased but no recent data is available regarding actual postponement rate and possible causes in this region. The need is felt to assess the problem and suggest recommendations to decrease patients' sufferings and improve hospital workings.
Objectives: To assess the risk factors and postponement rate of elective surgical procedures on the same day of surgery in public sector tertiary care hospitals in Peshawar, Khyber Pakhtunkhwa, Pakistan.
Postponement is defined as cancellation of scheduled elective procedure on the day of operation.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
Who may qualify
- Ages
- 15 years and older
- Sex
- All
- Age groups
- Child, Adult, Older adult
- Study population
- All inpatients admitted in surgical departments of three tertiary care hospitals[ MTI-(HMC, KTH,LRH)], Peshawar, Pakistan and scheduled for elective general surgical procedures.
Key inclusion criteria (1 listed)
- All inpatients of any age and either sex admitted in general surgery departments, scheduled for elective surgeries including laparoscopic surgeries, who arrive or are brought to operation theatre for general surgeries as elective cases.
Key exclusion criteria (3 listed)
- All outdoor patients.
- Indoor cases of cardiac, cardiovascular, obstetrics and gynecology, neurosurgery, orthopedics, pediatrics or transplant surgeries or other surgeries considered as specialized surgeries.
- Emergency surgeries.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
Postponement rate of elective surgical procedures
Time frame: Eight hours
Postponement/ cancellation rate of elective surgical procedures on the same day of surgery will be calculated. Postponement rate= Total number of elective procedures cancelled / Total number of general surgeries performed in the defined time period * 100
1 secondary outcome
Risk factors assessment of postponement
Time frame: Eight hours
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 14 Jul 2023.
- Background: PubMed 25924834Meara JG, Leather AJ, Hagander L, Alkire BC, Alonso N, Ameh EA, Bickler SW, Conteh L, Dare AJ, Davies J, Merisier ED, El-Halabi S, Farmer PE, Gawande A, Gillies R, Greenberg SL, Grimes CE, Gruen RL, Ismail EA, Kamara TB, Lavy C, Lundeg G, Mkandawire NC, Raykar NP, Riesel JN, Rodas E, Rose J, Roy N, Shrime MG, Sullivan R, Verguet S, Watters D, Weiser TG, Wilson IH, Yamey G, Yip W. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015 Aug 8;386(9993):569-624. doi: 10.1016/S0140-6736(15)60160-X. Epub 2015 Apr 26. No abstract available.
- Background: PubMed 34568611Abate 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. Int J Surg Open. 2020;26:55-63. doi: 10.1016/j.ijso.2020.08.006. Epub 2020 Aug 20.
- Background: PubMed 34130956O'Rielly C, Ng-Kamstra J, Kania-Richmond A, Dort J, White J, Robert J, Brindle M, Sauro K. Surgery and COVID-19: a rapid scoping review of the impact of the first wave of COVID-19 on surgical services. BMJ Open. 2021 Jun 15;11(6):e043966. doi: 10.1136/bmjopen-2020-043966.
- Background: PubMed 22494485Tagarakis GI, Voucharas C, Simopoulos V, Karangelis D, Daskalopoulos ME, Parisis C, Tsantilas A, Sataitidis I, Lampoura S, Vretzakis G, Tsilimingas NB. Why are thoracic operations postponed? J Cardiothorac Surg. 2012 Apr 11;7:31. doi: 10.1186/1749-8090-7-31.
- Background: PubMed 28712245Kurji Z, Premani ZS, Mithani Y. Analysis Of The Health Care System Of Pakistan: Lessons Learnt And Way Forward. J Ayub Med Coll Abbottabad. 2016 Jul-Sep;28(3):601-604.
- Background: PubMed 33085061Sommer JL, Jacobsohn E, El-Gabalawy R. Impacts of elective surgical cancellations and postponements in Canada. Can J Anaesth. 2021 Mar;68(3):315-323. doi: 10.1007/s12630-020-01824-z. Epub 2020 Oct 21.
- Backgroundmarymarcus. CAUSES OF POSTPONEMENT OF ELECTIVE SURGERY IN MAYO HOSPITAL LAHORE [PDF] [Internet]. Presentica. 2020 [cited 2021 Dec 27]. Available from: https://www.presentica.com/doc/10371391/causes-of-postponement-of-elective-surgery-in-mayo-hospital-lahore
- Background: PubMed 21124662Bathla S, Mohta A, Gupta A, Kamal G. Cancellation of elective cases in pediatric surgery: An audit. J Indian Assoc Pediatr Surg. 2010 Jul;15(3):90-2. doi: 10.4103/0971-9261.71748.
- Background: PubMed 18444594Zafar A, Mufti TS, Griffin S, Ahmed S, Ansari JA. Cancelled elective general surgical operations in Ayub Teaching Hospital. J Ayub Med Coll Abbottabad. 2007 Jul-Sep;19(3):64-6.
- Individual participant dataSharing planned: Yes. Data including clinical and demographic characteristics, not affecting patient's confidentiality, will be shared.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Rahman U Jan principal investigator
Hayatabad Medical Complex
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Surgical Procedure, run by Hayatabad Medical Complex at 1 site in Pakistan.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 14 Jul 2023. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Pakistan. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Postponement rate of elective surgical procedures (time frame: Eight hours). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT05352984, which also lists 9 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 14 Jul 2023.