Your surgical team has assembled for an early morning procedure. You’re now just waiting for the patient to be prepped and brought in. As you finish your own preparations, one of your nurses enters and informs you that the patient had forgotten their instructions and had coffee and a donut on the way to surgery.

Unfortunately, this is not an uncommon event. On average, 14% of elective procedures are canceled on the day of the scheduled surgery.

What makes these last-minute or day-of cancelations more annoying is that according to the National Institutes of Health (NIH), as many as 83% of canceled elective surgeries are “potentially preventable.” Additionally, separate research published in the healthcare journal BMC Health Services Research found that 71% of cancellations could have been avoided. Yet we continue to see the trend of canceled, rescheduled, or missed surgeries on the rise.

A 2009 study from Tulane University Medical Center found that canceled surgeries cost the hospital nearly $1.5 million in lost revenue, or $4,550 per case. When adjusted for inflation, that’s equal to about $6,000 per surgery in 2022.

The cost of preventable cancelations

Late and last-minute cancelations aren’t just annoying; they’re also expensive.

A 2009 study from Tulane University Medical Center found that canceled surgeries cost the hospital nearly $1.5 million in lost revenue, or $4,550 per case. When adjusted for inflation, that’s equal to about $6,000 per surgery in 2022.

The researchers also said approximately 24% of those cancellations were due to preoperative instructions not being followed. To put it another way, eliminating just the cancelations due to unfollowed pre-op instructions would save a surgical center like Tulane at least $375,000 per year.

“It’s an expensive mistake,” said Board-certified Oral and Maxillofacial surgeon Dr. Will Perkinson. “In an outpatient setting, you lose money when your assistants are standing around for an hour waiting for a surgery that never begins.”

Plus, there is a loss of productivity. “There’s something to be said for being able to stay on schedule,” Dr. Perkinson explained. “Everything runs more smoothly. If my people are down for an hour, it takes more energy to get everyone moving again. You lose a lot of clinical momentum.”

A canceled surgery represents a time slot that could have gone to another patient who might have the same, if not a more urgent, health concern. Morning appointments tend to be the most popular time slots due to the preoperative norm of not eating or drinking before surgery.

“Patient anxiety increases exponentially the later in the day it gets,” Dr. Perkinson said. Research has shown that increased anxiety before surgery can hinder patients’ overall health outcomes. Patients may experience high blood pressure during the procedure, which can trigger complications.

Dr. Perkinson says at his practice, his clinical team might schedule a procedure like wisdom teeth removal up to 6 months in advance, which makes it challenging to keep his patients up-to-speed on all preoperative tasks.

Understanding the underlying reasons for cancelations

Failure to follow pre-surgery instructions is one of the main causes of last-minute and day-of cancelations. These patient compliance failures include not eating solid food for 12 hours before their surgery.

Dr. Perkinson says patients not fully complying with presurgical routines is the second most common reason for canceling a procedure at his practice. “We don’t usually figure that one out until the patient arrives.”

That brings us to another major reason for preventable cancelations: the patient doesn’t even show up. A 2012 study in the Journal of Anaesthesiology, Clinical Pharmacology, found that 32% of the surgery cancelations at a 500-bed hospital the researchers studied was due to patients not showing up for their scheduled procedure.

The main reason for these “no show” cancelations is patient anxiety. A 2014 study by BMC Surgery found that 70% of patients had “significant preoperative anxiety.” Many patients experience anxiety before undergoing surgery. The process can be very scary, especially when the procedure involves anesthesia. Part of the challenge patients face when getting ready for surgery, along with the burden of mentally preparing themselves, is that it’s easy to forget or misplace the preoperative instructions they received prior to their surgical appointment.

A third reason for surgical cancelations is that when the patient does arrive for the procedure, they are found to be medically unfit. A 2013 study published in the Journal of Anesthesia & Clinical Research found that such changes in the patient’s medical condition accounted for about 10% of surgical cancelations.

Most elective procedures are scheduled weeks, if not months, in advance. The median wait time for elective surgery is 3-4 months, according to OECD data. Much can change in the patient’s condition in that period.

Dr. Perkinson says at his practice, his clinical team might schedule a procedure like wisdom teeth removal up to 6 months in advance, which makes it challenging to keep his patients up-to-speed on all preoperative tasks.

Using digital health to bridge the gap

Optimizing communication between providers and patients is key to reducing last-minute surgery cancellations. Increased digital engagement is a common-sense method to accomplish this goal. A recent survey found that, on average, American adults spend nearly 3 hours looking at their phones every day. In addition, 70% said they check their phones within 5 minutes of receiving a personalized notification.

Focusing on digital engagement and communication solutions can increase efficiency in provider offices like Dr. Perkinson’s, who explained that his office manager currently calls about 50 patients each day. Many of those calls are to patients with upcoming surgeries and the office manager needs to remind them of preoperative procedural instructions, but only a fraction of the patients may answer the phone. There’s no way for Dr. Perkinson or his clinical team to know if their patients actually listened to the voicemails.

Based on the data cited above, providers are far more likely to reach patients through digital methods. “I think people respond better to a text message,” Dr. Perkinson weighed in. “They can look at the message on their own time, instead of trying to answer the phone while they’re distracted by other things going on.” This would be especially beneficial for sharing updated patient pathways and pre-surgical procedural information in real-time.

Here’s how digital health tools can help eliminate the three types of last-minute preventable cancelations noted above:

• Pre-op instructions. A digital health app can continuously guide patients in the days and even hours before the procedure to ensure they follow their surgeon’s pre-op instructions. Calcium’s perioperative solution, for example, can provide email and push notification reminders even in the hours before the procedure to keep the patient on track.
• Anxiety reduction. A digital health app can help reduce a patient’s anxiety about the surgery by providing a mix of education, affirmation and action steps to help calm the patient. Calcium’s perioperative solution, for example, can provide informative videos and articles. But it can also provide steps to help patients calm themselves – as well quick checks as allow surgical centers to monitor their anxiety levels.
• Staying medically fit. A digital health app can monitor a patient’s medical condition and continued eligibility for a procedure over weeks and months. For example, Calcium’s perioperative solution can monitor the patient’s weight, blood pressure and other metrics as the patient waits for their scheduled procedure. The app can then alert the surgical coordinator if the surgery needs to be scheduled – days or even weeks ahead of time.

Using digital health to improve post-op recovery

Preoperative education and communications are key to carrying out a successful surgery, but this dialogue between providers and patients is just as important after the procedure is over. Patients typically have postoperative procedures and personal care routines they need to follow throughout the recovery period in order to avoid ending up back in the hospital.

According to the Nationwide Readmissions Database, approximately 22% of patients are readmitted to the hospital within 90 days of surgery. The most common reason for hospital readmission is surgical wound infections, which can cause patients significant pain. Regular reminders to the patients about how to keep the surgical area clean or what to do if they experience post-op itching, for example, could help keep many patients out of the hospital.

Reducing waste while improving attendance and surgical health outcomes

One of the benefits of the evolving digital health industry is that providers and clinicians can reduce waste (or loss) while also improving health outcomes and patient satisfaction.

As noted above, surgery centers and surgeons now have the ability to eliminate much of the annoyance and cost of preventable same-day cancelations. Digital health technology such as Calcium’s Perioperative solution helps to optimize patient engagement, education and monitoring that, in turn, help improve patient compliance and health outcomes.

And in addition to improving patient satisfaction, these same solutions can also help improve staff productivity and satisfaction.