Protocol for health professionals’ perspectives on elective surgical case cancellations in selected public hospitals: A quantitative cross-sectional study in South Africa’s Eastern Cape and Mpumalanga provinces

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Elective surgical case cancellations represent a persistent and complex challenge faced by healthcare systems globally, often reflecting systemic inefficiencies and resource limitations. While existing research has predominantly focused on quantifying cancellation rates and categorising causes through retrospective institutional data, few studies have explored the insights of healthcare professionals, key frontline stakeholders who play a critical role in identifying and addressing cancellations. This study seeks to address this gap by examining healthcare professionals’ perspectives on elective surgical case cancellations within selected public hospitals in South Africa. This study will employ a quantitative cross-sectional survey to identify and understand the factors contributing to the cancellations of theatre cases from healthcare professionals’ perspectives. A convenient non-probability sampling technique will be utilised to collect data using a structured questionnaire from healthcare professionals who are readily available and willing to participate during the study period. Quantitative data analysis will involve entering survey data into Microsoft Excel 2021 for Windows and subsequently exporting it to STATA version 18.5 for advanced analysis. Descriptive and categorical data will be compared using frequencies, percentages, and graphical representations. Ethical clearance has been granted by the Human Research Ethics Committee of the Faculty of Medicine and Health Sciences at Walter Sisulu University, Ref: WSU HREC 051/2025. Approval to access the research sites has been obtained from both the Provincial Health Research Committees of the Eastern Cape (Ref: EC_202505_029) and Mpumalanga (Ref: MP_202506_003) departments. Results will be shared with key stakeholders through public presentations, conferences, and published in peer-reviewed journals." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/14-802/v1", "name": "Protocol for health professionals’ perspectives on elective surgical..." } } ] } Home Browse Protocol for health professionals’ perspectives on elective surgical... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Maake K, Chitha W, Nomatshila S and Mabunda S. Protocol for health professionals’ perspectives on elective surgical case cancellations in selected public hospitals: A quantitative cross-sectional study in South Africa’s Eastern Cape and Mpumalanga provinces [version 1; peer review: 1 approved] . F1000Research 2025, 14 :802 ( https://doi.org/10.12688/f1000research.169011.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Study Protocol Protocol for health professionals’ perspectives on elective surgical case cancellations in selected public hospitals: A quantitative cross-sectional study in South Africa’s Eastern Cape and Mpumalanga provinces [version 1; peer review: 1 approved] Kedibone Maake https://orcid.org/0000-0002-5622-2839 1,2 , Wezile Chitha 1,2 , Sibusiso Nomatshila 1,3 , Sikhumbuzo Mabunda https://orcid.org/0000-0001-9458-3742 1,4-6 Kedibone Maake https://orcid.org/0000-0002-5622-2839 1,2 , Wezile Chitha 1,2 , Sibusiso Nomatshila 1,3 , Sikhumbuzo Mabunda https://orcid.org/0000-0001-9458-3742 1,4-6 PUBLISHED 19 Aug 2025 Author details Author details 1 Public Health, Walter Sisulu University, Mthatha, Eastern Cape, South Africa 2 Institute for Clinical Governance and Healthcare Administration, Walter Sisulu University, Mthatha, Eastern Cape, South Africa 3 Society and Health Research Institute, Walter Sisulu University, Mthatha, Eastern Cape, South Africa 4 Global Center for Human Resources for Health Intelligence, Walter Sisulu University, Mthatha, Eastern Cape, 5117, South Africa 5 School of Population Health, University of New South wales, Sydney, New South Wales, Australia 6 George Institute of Global Health, University of New South Wales, Sydney, New South wales, Australia Kedibone Maake Roles: Resources, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Wezile Chitha Roles: Conceptualization, Funding Acquisition, Writing – Review & Editing Sibusiso Nomatshila Roles: Project Administration, Writing – Original Draft Preparation Sikhumbuzo Mabunda Roles: Methodology, Resources, Supervision, Validation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract The efficient functioning of surgical services in public hospitals is a cornerstone of effective healthcare delivery, influencing not only operational performance but also patient outcomes and the overall utilisation of resources within the health system. Elective surgical case cancellations represent a persistent and complex challenge faced by healthcare systems globally, often reflecting systemic inefficiencies and resource limitations. While existing research has predominantly focused on quantifying cancellation rates and categorising causes through retrospective institutional data, few studies have explored the insights of healthcare professionals, key frontline stakeholders who play a critical role in identifying and addressing cancellations. This study seeks to address this gap by examining healthcare professionals’ perspectives on elective surgical case cancellations within selected public hospitals in South Africa. This study will employ a quantitative cross-sectional survey to identify and understand the factors contributing to the cancellations of theatre cases from healthcare professionals’ perspectives. A convenient non-probability sampling technique will be utilised to collect data using a structured questionnaire from healthcare professionals who are readily available and willing to participate during the study period. Quantitative data analysis will involve entering survey data into Microsoft Excel 2021 for Windows and subsequently exporting it to STATA version 18.5 for advanced analysis. Descriptive and categorical data will be compared using frequencies, percentages, and graphical representations. Ethical clearance has been granted by the Human Research Ethics Committee of the Faculty of Medicine and Health Sciences at Walter Sisulu University, Ref: WSU HREC 051/2025. Approval to access the research sites has been obtained from both the Provincial Health Research Committees of the Eastern Cape (Ref: EC_202505_029) and Mpumalanga (Ref: MP_202506_003) departments. Results will be shared with key stakeholders through public presentations, conferences, and published in peer-reviewed journals. READ ALL READ LESS Keywords Health professionals, elective surgical case cancellations, public hospitals, South Africa Corresponding Author(s) Kedibone Maake ( [email protected] ) Close Corresponding author: Kedibone Maake Competing interests: No competing interests were disclosed. Grant information: This research will be funded by a grant from the South African Medical Research Council, grant number: HDID6032_SB2021. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2025 Maake K et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Maake K, Chitha W, Nomatshila S and Mabunda S. Protocol for health professionals’ perspectives on elective surgical case cancellations in selected public hospitals: A quantitative cross-sectional study in South Africa’s Eastern Cape and Mpumalanga provinces [version 1; peer review: 1 approved] . F1000Research 2025, 14 :802 ( https://doi.org/10.12688/f1000research.169011.1 ) First published: 19 Aug 2025, 14 :802 ( https://doi.org/10.12688/f1000research.169011.1 ) Latest published: 19 Aug 2025, 14 :802 ( https://doi.org/10.12688/f1000research.169011.1 ) Introduction Efficient functioning of surgical services within public hospitals is fundamental to healthcare delivery, impacting not only operational performance but also patient outcomes and system-wide resource utilisation. 1 – 3 Elective surgical case cancellations pose a persistent and multifaceted challenge in healthcare systems globally, often signifying systemic inefficiencies and limitations in resources. 1 Defined as the non-performance of scheduled surgeries on the intended date, these cancellations not only disrupt clinical workflows but also lead to wasted operating theatre time, increased healthcare costs, prolonged patient waiting periods, and a decline in trust toward the healthcare system. 2 – 4 Elective surgical case cancellation remains a prevalent challenge in healthcare systems globally, particularly in low to middle-income countries (LMICs) like South Africa, with prevalence rates reaching as high as 34 percent, significantly exceeding the global average of approximately 18 percent. 1 , 5 , 6 These cancellations contribute to reduced operating theatre efficiency, financial losses, and psychological distress among patients and families. 7 , 8 In LMICs, high cancellation rates exacerbate existing strains on public hospitals, where resource constraints, staff shortages, and systemic inefficiencies are prevalent. 9 Literature identifies various factors contributing to the cancellation of theatre cases, categorised into patient-related, systemic inefficiencies, and clinician-related reasons. 10 , 11 Patient-related factors may comprise non-attendance, lack of pre-operative preparation, medical comorbidities, and logistical concerns such as inadequate resources. 1 , 12 Systemic inefficiencies, such as insufficient resources like operating rooms or staff, scheduling conflicts due to poor coordination, and administrative errors like incorrect patient information, are also significant contributors to surgical case cancellations. 1 , 12 Clinician-related factors may include inadequate communication among team members, surgeons’ availability, and various procedural inefficiencies. 4 , 13 In a study by Sukwana et al. (2023), cancellations were distributed based on their preventability, with 52.6% classified as avoidable, 6.2% as potentially preventable, 25.2% as difficult to avoid, and 16% as unavoidable. In LMICs with limited resources, cancelling elective surgical operations for various preventable reasons is common in many hospitals, and this situation is also prevalent in most African countries. 15 Cancellations of scheduled elective operations significantly strain health resources in LMICs; in addition to hospital inpatient costs, the government also incurs substantial expenses in transporting patients to and from referring hospitals. 16 Realistic strategies to reduce cancellations cannot be established without understanding the underlying reasons for these occurrences in LMICs. 1 , 17 The South African healthcare system faces multiple systemic challenges, contributing to frequent surgical cancellations, further exacerbating backlogs, and further straining an already overburdened healthcare system. 4 , 17 , 18 For public sector hospitals in South Africa, where resources are already strained and healthcare inequities persist, understanding the drivers and consequences of surgical cancellations is crucial to enhancing service quality and equity. 4 , 17 , 18 International benchmarks suggest that cancellation rates should not exceed 5%, yet studies in South African public hospitals report rates as high as 14.4%–39%, far surpassing this threshold. 4 , 9 Public hospitals, particularly those in rural and under-resourced provinces like the Eastern Cape and Mpumalanga, face unique challenges that intensify the burden of surgical cancellations. 4 , 19 These include inadequate staffing, equipment shortages, logistical inefficiencies, and weak interdepartmental coordination. 17 – 19 While much of the global literature has focused on quantifying cancellation rates and categorising causes from institutional data, 1 – 4 there is a relative paucity of research capturing the firsthand perspectives of healthcare professionals who are directly involved in perioperative care and theatre management. The consequences of cancellations extend beyond operational inefficiencies. 2 Healthcare workers, already operating under stress, experience demoralisation and burnout due to recurrent workflow disruptions. 2 While prior research has quantified cancellation rates and their causes in South Africa, 4 , 9 , 14 few studies have centered on healthcare professionals’ perspectives, despite their frontline role in identifying and mitigating cancellations. Therefore, this study aims to fill that gap by examining healthcare professionals’ perspectives on elective surgical case cancellations within selected public hospitals in the Eastern Cape and Mpumalanga provinces. The findings from this study will not only contribute to the national discourse on health system strengthening but also offer practical guidance for hospital administrators, policymakers, and healthcare teams aiming to reduce cancellations and improve surgical care delivery. Protocol Study setting The study will be conducted in two mostly rural provinces of South Africa, the Eastern Cape and Mpumalanga, both characterised by high levels of poverty, unemployment, and socioeconomic inequality, which significantly affect healthcare outcomes. 20 , 21 A large portion of the population depends on public health facilities for their healthcare needs. 20 Despite substantial interventions, strategies, and investments by the Department of Health aimed at strengthening the health system’s capacity to deliver quality healthcare services, both provinces continue to exhibit poor health outcomes. 22 , 23 The study will take place in four hospitals: Nelson Mandela Academic Hospital and St Elizabeth Hospital in the Eastern Cape, and Rob Ferreira Hospital and Themba Hospital in Mpumalanga. These selected hospitals serve as referral facilities within their respective provinces, offering various levels of specialised healthcare services. To ensure an unbiased and representative sample, a simple random sampling technique was employed in the selection of hospitals for the study. Study design This study will employ a quantitative, cross-sectional survey design to systematically investigate the factors contributing to surgical theatre case cancellations in selected public hospitals in the Eastern Cape and Mpumalanga provinces, South Africa. The cross-sectional nature of the design allows for data collection at a single point in time, providing insights into the current state of factors influencing theatre cancellations from the perspectives of healthcare providers. The survey will target healthcare professionals in surgical wards and theatres, specifically doctors and nurses, to explore their perspectives and experiences. By using structured surveys, this research aims to produce findings that are generalisable, which can guide targeted interventions to reduce cancellations and improve surgical efficiency in settings with limited resources. Population and sampling A convenient non-probability sampling technique will be utilised. 24 This technique will allow data collection from healthcare professionals who are readily available and willing to participate during the study period. This is particularly useful in busy environments like surgical wards and theatres where time and availability can be limited. The technique ensures that the study can include enough participants without disrupting essential duties. The study population will comprise all healthcare professionals in the surgical wards and theatres of the selected public hospitals in the Eastern Cape and Mpumalanga provinces. This will include nurses (professional nurses, enrolled nurses, nursing assistants) and doctors (surgeons, anesthetists, and other relevant medical practitioners) involved in surgical care who fulfill the study’s inclusion criteria during the designated period. Data collection Data will be collected using a structured questionnaire designed to capture the perspectives and experiences of healthcare providers regarding the factors contributing to the cancellations of theatre cases. The research questionnaire was designed based on the formats provided in previous empirical literature 4 , 25 and validated for this study by two public health physicians. The questionnaire will include sections on demographic information, including age, gender, professional role, and years of experience. Institutional factors such as the availability of resources and scheduling practices. Patient-related factors, such as patient preparedness and cancellations due to patient conditions. Systemic factors, such as administrative issues and policy-related factors. Data collection will involve distributing structured questionnaires to selected surgical wards and theatre healthcare professionals. Participation will be voluntary, and informed consent will be obtained from all participants before completing the survey. To enhance response rates, reminders will be sent, and participants can complete the survey in either paper format or electronically via a secure online platform, depending on the hospital’s resources and preferences. Validity and reliability To ensure validity, researchers invested careful consideration in designing a questionnaire that would only measure what it intended to measure. To further strengthen the reliability of the data collection instruments, tools used in previous research were adapted to align with the study’s specific research questions and objectives. Additionally, the participation of trained researchers in the data collection process will further enhance the reliability of the information gathered. A pilot study will be conducted to evaluate whether the data collection tools effectively measure the intended concepts. 26 A pre-test questionnaire 26 will be administered to ten participants at a referral hospital in the Eastern Cape province who share similarities with the target sample population. The questionnaires will undergo this pre-testing to identify potential problem areas, minimise measurement error, ascertain if participants interpret questions correctly, and confirm that the sequence of questions does not influence participants’ responses. The questionnaire will only be finalised after the researcher completes the pre-testing and makes necessary modifications based on feedback from the pre-test. Data management and analysis Quantitative data analysis will involve entering survey data into Microsoft Excel 2021 for Windows and subsequently exporting it to STATA version 18.5 for advanced analysis. Descriptive and categorical data will be compared using frequencies, percentages, and graphical representations. The normality of numerical data will be evaluated using the Shapiro-Wilk test. The mean, range, and standard deviation will be reported for data that meets the normal distribution criteria. In contrast, the median and interquartile range (IQR) will be utilised for non-normally distributed data. Statistical comparisons will rely on the Chi-squared or Fisher’s exact test based on the expected frequencies. A significance level of p-value ≤ 0.05 will be adopted, along with a 95% confidence interval to ensure the precision of estimates. Dissemination Research findings will be communicated through various dissemination methods, including workshops, media releases, seminars, and conferences, as well as publications in peer-reviewed journals. This approach will ensure that the findings reach the appropriate stakeholders and can effectively inform decisions, policies, and future research initiatives. Study status Participant recruitment and data collection will be conducted concurrently from 01 October 2025 to 28 November 2025. During this timeframe, eligible healthcare professionals will be sampled to participate in the study. Data analysis and interpretation are set to begin on 12 January 2026, with completion anticipated by 28 March 2026. As of this submission, none of the study phases, including recruitment, data collection, or analysis, have been initiated. Discussion This study aims to identify the key determinants of theatre cancellations, reflecting findings from similar contexts in LMICs, where resource shortages, administrative inefficiencies, and patient-related issues often disrupt surgical workflows. 1 Institutional constraints, such as insufficient equipment, staffing shortages, and poor scheduling, are expected to be significant barriers, aligning with prior research that has highlighted systemic weaknesses within South Africa’s public health sector. 4 Additionally, patient-related factors, such as late arrivals, inadequate preoperative preparation, or acute clinical deterioration, may further exacerbate cancellations, as observed in comparable studies in LMICs. 1 The perspectives of healthcare professionals will provide invaluable insights into operational inefficiencies that are often overlooked in top-down policy evaluations. Their firsthand experiences may uncover gaps in hospital management, including fragmented communication between surgical teams and administrative staff, which can exacerbate delays. By quantifying these factors, this study will add to the growing body of literature advocating for the enhancement of surgical systems in under-resourced settings. If, as expected, resource scarcity and logistical inefficiencies emerge as significant contributors, targeted interventions such as improved supply chain management, predictive scheduling algorithms, and enhanced preoperative patient assessment protocols could help reduce cancellations. While the study design provides robust quantitative data collection, several limitations warrant consideration. The cross-sectional nature of the study limits causal inference, capturing only a snapshot of healthcare professionals’ perceptions at a single point in time. Employing a longitudinal approach could offer deeper insights into trends and contextual variation. Future research could benefit from the inclusion of qualitative interviews to explore the underlying systemic barriers in greater depth. Despite these limitations, the study results are expected to inform policy and operational improvements. By clarifying the multifactorial causes of cancellations from resource deficiencies to administrative shortcomings, the research will provide actionable evidence for enhancing surgical efficiency. Addressing these challenges is essential not only for reducing procedural delays but also for promoting equitable access to timely surgical care in alignment with global health equity goals. Ethics and consent statement Ethical clearance was obtained from the Research Ethics Committee of the Faculty of Health Sciences at Walter Sisulu University, Ref: WSU HREC 051/2025. Approval to access the research sites was obtained from the Provincial Health Research Committees of both the Eastern Cape (Ref: EC_202505_029) and the Mpumalanga (Ref: MP_202506_003) Department of Health. Before data collection, entry to the study sites will be further negotiated with the hospital CEOs. The study will abide by the 4 ethical principles of autonomy, beneficence, non-maleficence, and justice. Informed consent forms will be signed by all participants in the study. These forms will be clearly explained, outlining the study’s purpose, objectives, participant expectations, and any potential risks and benefits associated with participation. Participants will be reassured that their involvement in this study is completely voluntary and that their confidentiality will be maintained throughout the research process. They will also be informed that they can withdraw from the study at any time and choose not to answer any questions they find uncomfortable without facing any negative repercussions. All identifying information will be removed, and all electronic records will be securely encrypted with a password, accessible only to the researchers. Data availability Underlying data No data is associated with this article. Acknowledgements The authors wish to thank the Eastern Cape and Mpumalanga Department of Health for allowing this study to be conducted in their healthcare facilities. References 1. Abate SM, Chekole YA, Minaye SY, et al. : Global prevalence and reasons for case cancellation on the intended day of surgery: a systematic review and meta-analysis. Int. J. Surg. Open. 2020 Jan 1; 26 : 55–63. PubMed Abstract | Publisher Full Text | Free Full Text 2. Armoeyan M, Aarabi A, Akbari L: The effects of surgery cancellation on patients, families, and staff: a prospective cross-sectional study. J. Perianesth. Nurs. 2021 Dec 1; 36 (6): 695–701.e2. PubMed Abstract | Publisher Full Text 3. Koh WX, et al. : Cancellation of elective surgery: rates, reasons and effect on patient satisfaction. Can. J. Surg. 2021; 64 (2): E155–E161. PubMed Abstract | Publisher Full Text | Free Full Text 4. Sukwana A, Mrara B, Oladimeji O: Prevalence and causes of elective surgical cancellations: findings from a rural Tertiary Hospital in the Eastern Cape, South Africa. Healthcare. MDPI; 2023 Jan 15; Vol. 11 (2): p. 270. PubMed Abstract | Publisher Full Text | Free Full Text 5. Ayalew TL: Case cancellations and associated factors on the day of surgery in hospitals of Wolaita Zone, South Ethiopia. BMC Surg. 2024 Feb 4; 24 (1): 45. PubMed Abstract | Publisher Full Text | Free Full Text 6. Chinyakata R, Roman NV, Msiza FB: Stakeholders’ perspectives on the barriers to accessing health care services in rural settings: A human capability approach.uwcscholar.uwc.ac.za.2021. 7. Chua I, Duff J, Munday J: Elective Day of surgery cancellations: A retrospective observational study. Collegian. 2023 Oct 1; 30 (5): 721–726. Publisher Full Text 8. Engidayehu T, Ayalew Y, Gela D, et al. : Cancellation of Elective Surgery and Its Associated Factors in Public Teaching Hospitals of Addis Ababa, Ethiopia, 2021. SAGE Open. 2024 Nov; 14 (4): 21582440241300519. Publisher Full Text 9. Nair S, Cotwall F, Basu D, et al. : An Audit of Theatre Operating Efficiency at a Central Hospital in South Africa. Perioper. Care Oper. Room Manag. 2025 Jun 10; 40 : 100506. Publisher Full Text 10. Al Talalwah N, McIltrot KH: Cancellation of surgeries: integrative review. J. Perianesth. Nurs. 2019 Feb 1; 34 (1): 86–96. Publisher Full Text 11. Wong DJ, Harris SK, Moonesinghe SR, et al. : Cancelled operations: a 7-day cohort study of planned adult inpatient surgery in 245 UK National Health Service hospitals. Br. J. Anaesth. 2018 Oct 1; 121 (4): 730–738. PubMed Abstract | Publisher Full Text 12. Sabounji SM, Fall M, Seye C, et al. : Cancellation causes of elective surgical procedures in a major pediatric surgery department. Open J. Pediatr. 2022 Jan 6; 12 (1): 131–136. Publisher Full Text 13. Amani B, Omar A: Factors affecting surgical delay: a case study of one of general hospital at Jeddah City. Current Trends in Disease and Health. 2020 Mar 4; 125 . 14. Asmal II, Cronjé L, Keerath K: An audit of operating theatre utilisation and day-of-surgery cancellations at a regional hospital in the Durban metropole. S. Afr. Med. J. 2019 Oct 1; 109 (10): 765–770. PubMed Abstract | Publisher Full Text 15. Gajida AU, Takai IU, Nuhu YN: Cancellations of elective surgical procedures performed at a Teaching Hospital in North-West Nigeria. J. Med. Trop. 2016 Jul 1; 18 (2): 108–112. Publisher Full Text 16. Sarang B, Bhandoria G, Patil P, et al. : Assessing the rates and reasons of elective surgical cancellations on the day of surgery: a multicentre study from urban Indian hospitals. World J. Surg. 2022 Feb; 46 (2): 382–390. PubMed Abstract | Publisher Full Text | Free Full Text 17. Fusheini A, Eyes J, Goudge J: The state of public hospital governance and management in a South African hospital: a case study. Int. J. Healthc. 2017 Oct 12; 3 (2): 68–77. Publisher Full Text 18. Maphumulo WT, Bhengu BR: Challenges of quality improvement in the healthcare of South Africa post-apartheid: A critical review. Curationis. 2019 Jan 1; 42 (1): 1–9. Publisher Full Text 19. Mathonsi P, Chinomona R, Schutte F: Interventions to Improve Service Delivery in Rural Mpumalanga Hospitals of South Africa. Int. J. Prof. Bus. Rev. 2023; 8 (5): 14. 20. Neely AH, Ponshunmugam A: A qualitative approach to examining health care access in rural South Africa. Soc. Sci. Med. 2019 Jun 1; 230 : 214–221. PubMed Abstract | Publisher Full Text 21. Ngobeni V, Breitenbach MC, Aye GC: Technical efficiency of provincial public healthcare in South Africa. Cost Eff. Resour. Alloc. 2020 Dec; 18 : 1–9. Publisher Full Text 22. Mathonsi P, Chinomona R, Schutte F: Interventions to Improve Service Delivery in Rural Mpumalanga Hospitals of South Africa. Int. J. Prof. Bus. Rev. 2023; 8 (5): 14. 23. Willie MM, Maqbool M: Access to public health services in South Africa’s rural Eastern Cape Province. Applied Sciences Research Periodicals. 2023 May 25; 1 (2): 35–54. Publisher Full Text 24. Golzar J, Noor S, Tajik O: Convenience sampling. International Journal of Education & Language Studies. 2022 Dec 1; 1 (2): 72–77. 25. Demilew BC, Yisak H, Terefe AA: Magnitude and causes of cancelation for elective surgical procedures in Debre Tabor General hospital: a cross-sectional study. SAGE Open Medicine. 2021 Mar; 9 : 20503121211003357. PubMed Abstract | Publisher Full Text | Free Full Text 26. Hilton CE: The importance of pretesting questionnaires: a field research example of cognitive pretesting the Exercise Referral Quality of Life Scale (ER-QLS). Int. J. Soc. Res. 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Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 19 Aug 2025 ADD YOUR COMMENT Comment Author details Author details 1 Public Health, Walter Sisulu University, Mthatha, Eastern Cape, South Africa 2 Institute for Clinical Governance and Healthcare Administration, Walter Sisulu University, Mthatha, Eastern Cape, South Africa 3 Society and Health Research Institute, Walter Sisulu University, Mthatha, Eastern Cape, South Africa 4 Global Center for Human Resources for Health Intelligence, Walter Sisulu University, Mthatha, Eastern Cape, 5117, South Africa 5 School of Population Health, University of New South wales, Sydney, New South Wales, Australia 6 George Institute of Global Health, University of New South Wales, Sydney, New South wales, Australia Kedibone Maake Roles: Resources, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Wezile Chitha Roles: Conceptualization, Funding Acquisition, Writing – Review & Editing Sibusiso Nomatshila Roles: Project Administration, Writing – Original Draft Preparation Sikhumbuzo Mabunda Roles: Methodology, Resources, Supervision, Validation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information This research will be funded by a grant from the South African Medical Research Council, grant number: HDID6032_SB2021. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (1) version 1 Published: 19 Aug 2025, 14:802 https://doi.org/10.12688/f1000research.169011.1 Copyright © 2025 Maake K et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Maake K, Chitha W, Nomatshila S and Mabunda S. Protocol for health professionals’ perspectives on elective surgical case cancellations in selected public hospitals: A quantitative cross-sectional study in South Africa’s Eastern Cape and Mpumalanga provinces [version 1; peer review: 1 approved] . F1000Research 2025, 14 :802 ( https://doi.org/10.12688/f1000research.169011.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 19 Aug 2025 Views 0 Cite How to cite this report: Özcan MS. Reviewer Report For: Protocol for health professionals’ perspectives on elective surgical case cancellations in selected public hospitals: A quantitative cross-sectional study in South Africa’s Eastern Cape and Mpumalanga provinces [version 1; peer review: 1 approved] . F1000Research 2025, 14 :802 ( https://doi.org/10.5256/f1000research.186291.r414864 ) The direct URL for this report is: https://f1000research.com/articles/14-802/v1#referee-response-414864 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 09 Oct 2025 Mustafa Soner Özcan , Anesthesiology and Reanimation, Suleyman Demirel University, Isparta, Isparta, Turkey Approved VIEWS 0 https://doi.org/10.5256/f1000research.186291.r414864 At first impression, the title is excessively long. It could be changed to a clear, informative, and concise title. Overall assessment: Surgical case cancellations represent a critical health system challenge with implications for both resource ... Continue reading READ ALL At first impression, the title is excessively long. It could be changed to a clear, informative, and concise title. Overall assessment: Surgical case cancellations represent a critical health system challenge with implications for both resource utilisation and patient safety. The manuscript offers an original perspective on an important healthcare issue and addresses a notable gap in the literature, particularly within the context of low- and middle-income countries (LMICs). Conducting the study across two provinces and multiple public hospitals enhances the potential generalisability of the findings. The manuscript is generally well-structured, with clearly defined objectives, appropriate ethical approvals, and a transparent description of the study procedures. Although no outcome data are yet presented, the methodological planning appears rigorous and comprehensive for a study protocol. Sample size and power analysis: The planned sample size has not been specified. Including a power calculation or at least an estimated minimum number of participants would substantially strengthen the scientific robustness and credibility of the protocol. Although the authors clearly defined the study population and indicated that a convenience sampling approach would be used, the protocol does not specify the target sample size and does not provide any power or precision calculations to verify the adequacy of the proposed sample. This omission limits the ability to assess whether the study will achieve sufficient statistical power to detect meaningful differences or estimate proportions with an acceptable level of precision. Questionnaire content: While the authors mention that the questionnaire was adapted from previous studies, the specific items or domains to be assessed are not detailed. Providing examples of key questions or constructs would improve methodological transparency and allow readers to better evaluate the validity of the instrument. Group comparisons: It is not clearly indicated whether differences between subgroups such as years of professional experience, role, or hospital setting will be analysed. Clarifying whether such comparative analyses are planned would enhance the depth and interpretive value of the study findings. S cope of surgical cancellations: The protocol does not specify whether cancellations occurring after patient admission to the operating theatre will be considered, or if the focus is limited to preoperative preparation. However, many cancellations occur intraoperatively or immediately before anaesthesia induction, as shown in several large-scale studies. Including this dimension within the survey would strengthen the comprehensiveness of the research and contribute to a more nuanced understanding of underlying causes. The authors are encouraged to explore this aspect further in both data collection and subsequent discussion of results. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests: No competing interests were disclosed. Reviewer Expertise: I am an anesthesiologist with substantial clinical and academic experience in preoperative evaluation, operating theatre management, and surgical case cancellations. My team and I have recently conducted research in this area, yielding notable findings. Given this background, I consider this topic particularly relevant and am pleased to contribute my perspective to the review of this important study. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Özcan MS. Reviewer Report For: Protocol for health professionals’ perspectives on elective surgical case cancellations in selected public hospitals: A quantitative cross-sectional study in South Africa’s Eastern Cape and Mpumalanga provinces [version 1; peer review: 1 approved] . F1000Research 2025, 14 :802 ( https://doi.org/10.5256/f1000research.186291.r414864 ) The direct URL for this report is: https://f1000research.com/articles/14-802/v1#referee-response-414864 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 19 Aug 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 1 19 Aug 25 read Mustafa Soner Özcan , Suleyman Demirel University, Isparta, Turkey Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Özcan M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 09 Oct 2025 | for Version 1 Mustafa Soner Özcan , Anesthesiology and Reanimation, Suleyman Demirel University, Isparta, Isparta, Turkey 0 Views copyright © 2025 Özcan M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions At first impression, the title is excessively long. It could be changed to a clear, informative, and concise title. Overall assessment: Surgical case cancellations represent a critical health system challenge with implications for both resource utilisation and patient safety. The manuscript offers an original perspective on an important healthcare issue and addresses a notable gap in the literature, particularly within the context of low- and middle-income countries (LMICs). Conducting the study across two provinces and multiple public hospitals enhances the potential generalisability of the findings. The manuscript is generally well-structured, with clearly defined objectives, appropriate ethical approvals, and a transparent description of the study procedures. Although no outcome data are yet presented, the methodological planning appears rigorous and comprehensive for a study protocol. Sample size and power analysis: The planned sample size has not been specified. Including a power calculation or at least an estimated minimum number of participants would substantially strengthen the scientific robustness and credibility of the protocol. Although the authors clearly defined the study population and indicated that a convenience sampling approach would be used, the protocol does not specify the target sample size and does not provide any power or precision calculations to verify the adequacy of the proposed sample. This omission limits the ability to assess whether the study will achieve sufficient statistical power to detect meaningful differences or estimate proportions with an acceptable level of precision. Questionnaire content: While the authors mention that the questionnaire was adapted from previous studies, the specific items or domains to be assessed are not detailed. Providing examples of key questions or constructs would improve methodological transparency and allow readers to better evaluate the validity of the instrument. Group comparisons: It is not clearly indicated whether differences between subgroups such as years of professional experience, role, or hospital setting will be analysed. Clarifying whether such comparative analyses are planned would enhance the depth and interpretive value of the study findings. S cope of surgical cancellations: The protocol does not specify whether cancellations occurring after patient admission to the operating theatre will be considered, or if the focus is limited to preoperative preparation. However, many cancellations occur intraoperatively or immediately before anaesthesia induction, as shown in several large-scale studies. Including this dimension within the survey would strengthen the comprehensiveness of the research and contribute to a more nuanced understanding of underlying causes. The authors are encouraged to explore this aspect further in both data collection and subsequent discussion of results. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests No competing interests were disclosed. Reviewer Expertise I am an anesthesiologist with substantial clinical and academic experience in preoperative evaluation, operating theatre management, and surgical case cancellations. My team and I have recently conducted research in this area, yielding notable findings. Given this background, I consider this topic particularly relevant and am pleased to contribute my perspective to the review of this important study. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Özcan MS. Peer Review Report For: Protocol for health professionals’ perspectives on elective surgical case cancellations in selected public hospitals: A quantitative cross-sectional study in South Africa’s Eastern Cape and Mpumalanga provinces [version 1; peer review: 1 approved] . F1000Research 2025, 14 :802 ( https://doi.org/10.5256/f1000research.186291.r414864) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-802/v1#referee-response-414864 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. 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