Reasons for cancellation of total knee arthroplasty surgery in NHS hospitals in the UK

Abstract

Aims Non-UK single-centre studies report total knee arthroplasty (TKA) cancellation rates of between 5% and 23%, with one UK study reporting 26%. Many occur at short notice and for avoidable medical reasons. This negatively affects patient wellbeing and typically results in a lost NHS tariff of £6,500 to £11,000 per cancellation. This study aimed to collect reasons for and timing of cancellation of TKA surgery at UK NHS hospitals. Methods Routinely collected data on TKA surgery cancellations were obtained from six NHS hospitals. Where reasons were not explicit, such as “patient unfit”, medical notes were consulted to establish the specific clinical reason. Data were coded into categories, compiled, and analyzed using descriptive statistics. Results A total of 9,403 cancellations occurred and 17,223 TKA procedures were performed at six NHS hospitals over five years (April 2018 to March 2023). Variability in reporting between Trusts precludes certainty about incidence rates. Cancellation categories were institutional (56%; n = 5,283), clinical (19%; n = 1,794), and patient preference (24%; n = 2,286). Reasons were missing for 0.4% (n = 40). Most occurred two to 14 days before surgery (60%; n = 5,659). One-quarter occurred at short notice (25%; n = 2,390). Most short-notice reasons were “bed not available” and “patient unfit”, with most clinical reasons being cardiac, infection, and wound. Conclusion One in four TKA cancellations occur at short notice. Most reasons relate to bed availability and patients not being fit for surgery, and are generalizable to other elective surgeries. There is an urgent need for targeted efficiency programmes and care pathways to prevent cancellations.