The incidence and impact of cancellations of elective paediatric surgery at a quaternary hospital in South Africa: A retrospective cohort design.

Sinenkosi  Dladla; Nana  Fening; Ellen Mapunda; Palesa Motshabi Chakane; Palesa Mogane

doi:10.51168/sjhrafrica.v7i2.2643

Authors

Sinenkosi Dladla Department of Anaesthesiology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.
Nana Fening Department of Anaesthesiology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.
Ellen Mapunda Department of Paediatric Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.
Palesa Motshabi Chakane Department of Anaesthesiology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.
Palesa Mogane Department of Anaesthesiology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.

DOI:

https://doi.org/10.51168/sjhrafrica.v7i2.2643

Keywords:

paediatric surgery, cancellation, elective, emergency

Abstract

Background

Cancellation of elective paediatric surgery remains a significant challenge in resource-constrained healthcare systems. These impose emotional, financial, and logistical burdens on patients, families, and healthcare institutions, while potentially compromising patient outcomes.

Objectives

To determine the incidence and causes of cancellations of elective paediatric surgical procedures at a South African quaternary academic hospital.

Methods

A retrospective cohort review was conducted of paediatric patients scheduled for elective surgery at Charlotte Maxeke Johannesburg Academic Hospital between 1 January 2018 and 31 December 2019.

Results

During the study period, 2,098 elective paediatric surgical procedures were scheduled. Of these, 778 procedures were cancelled (37.1%). The median age of patients was 3 years (IQR 0–7), and 65% were male. Institutional factors accounted for most cancellations at first booking (59.7%). The leading institutional causes were time constraints (57.5%) and unavailability of intensive care or high-care beds (21.5%). Parent-related factors contributed 22.3% of first cancellations, patient-related factors accounted for 15.5% of cancellations, with medical unfitness and respiratory tract infections being the most common reasons. Repeated cancellations were common, and 182 patients (8.7%) were ultimately lost to follow-up. Following cancellation, a notable proportion of patients later required emergency surgery, while three patients died before undergoing their planned procedures.

Conclusion

Elective paediatric surgery cancellations occurred at a high rate, largely driven by institutional resource limitations. Repeated cancellations, loss to follow-up, emergency surgical conversion, and mortality highlight the potential consequences of delayed surgical care.

Recommendations

Targeted interventions should focus on improving operating theatre efficiency, reducing time-related cancellations, and expanding access to intensive care and high-care beds. Establishment of a dedicated preoperative assessment clinic and enhanced communication with caregivers may decrease cancellations. Future prospective studies should evaluate the long-term clinical, psychosocial, and economic consequences of surgical cancellations and assess the effectiveness of quality-improvement interventions.

Author Biography

Sinenkosi Dladla, Department of Anaesthesiology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.

is a medical practitioner and anaesthesia specialist trainee affiliated with the Department of Anaesthesiology, University of the Witwatersrand, Johannesburg, South Africa. Her research interests include paediatric perioperative care and healthcare quality improvement.

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