The Incidence and Associated Factors of Patient Cancellation Scheduled for Elective Surgery From February to May at Debremarkos Comprehensive Spetialized Hospital, Debremarkos, Northwest Ethiopia, 2022 Gc. A Cross Sectional Study

The Incidence and Associated Factors of Patient Cancellation Scheduled for Elective Surgery From February to May at Debremarkos Comprehensive Spetialized Hospital, Debremarkos, Northwest Ethiopia, 2022 Gc. 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A Cross Sectional Study Yitayal Guadie, Yohannes Godie, Dires Birhanu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3887189/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: High rates of cancellation of surgical procedures are common in hospital settings which may subsequently lead to economic loss to hospitals besides the burden given to patients, their families, and medical teams. It is well recognized that cancellation of patients from elective theatre operating lists increases cost, decreases efficiency, duplicates workload, and wastes operating room time. Cancellation of elective surgical procedures also causes significant emotional trauma to the patients as well as their families and the community in general, and its impact on hospital resources is great due to prolonged hospitalization and the high cost of health care (1). This study aimed to assess the incidence and causes of patient cancellation scheduled for elective surgery in Debre Markos Comprehensive Specialized Hospital., Debremarkos, Northwest Ethiopia, 2022 GC. Methods and Materials : A prospective cross-sectional study was conducted on the cancellation of scheduled surgery at Debremarkos Comprehensive Specialized Hospital with a total of 282 sample size from February-01-May-13 consecutive months of 2022 G C. The data was collected from the operating room daily surgical schedule, preoperative anesthesia record sheet, primary physicians, and the anesthetist responsible for the preoperative assessment and conducting the case and by communicating patients if required. Analysis will be done by using SPSS (Version 20). Descriptive as well as analytic statistics are used for variables and data will be presented by tables, graphs, charts, and texts. Result: A total of 1055 patients were scheduled for elective Surgery in Debremarkos Comprehensive Specialized Hospital. During the study period 282(26.7%) of the patients had their surgery cancelled for various reasons in Debremarkos Comprehensive Specialized Hospital. The two most frequent reasons for cancellation were lack of bed (50.0%) and unfit for anesthesia (15.2%) in DMCSH. Conclusion and Recommendation : In conclusion, the cancellation rate of scheduled surgeries is high in general adult surgery at Debremarkos Comprehensive Specialized Hospital. The majority of causes are foreseeable and avoidable, and many are related to the hospital itself. We recommend that a facility for hospital preadmission be created. Cancellation Elective surgery Debremarkos compherasive specialized hospital Ethiopia Figures Figure 1 Figure 2 Figure 3 Figure 4 INTRODUCTION The advantages of preoperative patient assessment before the surgery are to optimize the medical condition of the patient before the surgical procedure, improve patient safety and satisfaction, reduction of resources in terms of preoperative medical consultation, and laboratory investigations, and reduce the length of hospital stay (2). Cancellation of elective operation on the intended day of surgery is considered when the patient’s name has appeared on the list for surgical operations but the operation was not done on the intended scheduled date (3). The operation theatre (OT) has been reported to be the heart of a hospital requiring considerable human resources and expenditure from the hospital budget (4). Most hospitals in developed countries invest considerable resources in maintaining operating suites and having surgeons and theatre staff available on an agreed schedule. However, in developing countries where resources are limited, cancellation of elective surgical operations due to various preventable reasons is a common phenomenon in most hospitals. It is well recognized that cancellation of patients from elective theatre operating lists increases cost, decreases efficiency, duplicates workload, and wastes operating room tim (5). Cancellation of elective surgical procedures causes significant emotional trauma to the patient as well as their families and the community. It is recognized that the cancellation of patients from elective operation increases cost, decreases efficiency, duplicates workload, and wastes operating room time (6). Elective surgery cancellation always leads to insufficient utilization of manpower and hospital resource and can also lead to an increase in patients' treatment expenses due to prolonged hospital stay and in many cases, repetition of preoperative preparation and management (7). The incidence of cancellation of elective surgical operations has been reported in the literature to range from 20–40%. The causes of cancellation of elective surgical procedures are multifactorial and they tend to vary from one hospital to another (8).In general, its impact on hospital resources is great due to prolonged hospitalization and the high cost of health care (9). Generally, this study aimed to analyze the frequency, associated factors, and trend of cancellation of elective surgery operations in our environment and to identify the appropriate solutions for better patient management. Methods and Materials Study area, design and Study period A hospital-based Prospective cross-sectional study was conducted in the Amhara region, East Gojam Debre Markos Comprehensive Specialized Hospital on patients who were scheduled for elective surgery from February 01 to April 30, 2022 GC. Source and Study of Populations All elective patients appointed for major surgery at DMCSH from February 01 – May 13, 2022, GC and all patients canceled from their elective surgery in surgical, obstetrics and gynecology, pediatrics and child health, and ophthalmic ward at DMCSH from February 01 – May 13, 2022, GC. Inclusion criteria and Exclusion criteria All Patients scheduled for elective surgery at DMCSH from February 01 – May 13, 2022, GC and data without full information, Patients scheduled in minor OR, and Patients who are operated on emergency. Sample size determination and sampling procedure A single population proportion formula, [n= (Z a/2) 2 p (1-p)/W 2 ], is used to estimate the sample size to be included in the study. Due to lack of similar study about the cause and incidence of patient cancellation scheduled for elective surgery, a 50% is used for sample size determination by considering the following assumptions; 95% confidence interval, Marginal error of 5% The sample size is determined by using 95% level of confidence (z = 1.96), 50% as probability of success (p = 0.5), 50% probability of failure (q = 1-p = 0.5), and 0.05 as margin error i.e d = 0.05 d = Z a/2 (p q/n) 1/2 n= (Z a/2 ) 2 *(p q)/d 2 n=(1.96) 2 * (0.5*0.5)/(0.05) 2 n = 384 , since N < 10,000, Where N = study population (Biostatics, eighth edition, page 194). nf = ni/1+(ni/N) nf = 384/1+(384/1055) = 282 Study variables The dependent variable is those patients cancelled from elective surgery and the independent variable is Socio-demographic factors, planned procedure, Availability of surgical equipment. Data collection tool and procedures The data were collected using a structured questionnaire. The questionnaire is developed in English version by revising literature from previous similar studies and several questions that address the objective of the study were developed. The data was collected by three-fourth and two third-year anesthesia students after being given adequate training. Data Quality Assurance and Data Management The two-day training was given about the data collection procedure for those data collectors and supervisors regarding the study purpose, how to conduct the interview, how to administer the questionnaire, how to give consent, keep confidentiality, and respect the rights of the participant. Data processing and analysis The data was processed and analyzed using SPPS version 20. The data was interpreted using descriptive statistics computed to determine frequency and percentage. The result will be presented by tables, bar graphs, and pie charts. Result During the study period 204 of the patients had their surgery cancelled for various reasons in Debre Markos Comprehensive Specialized Hospital. Reasons for cancellation are summarized in (table 2) for DMCSH. The two most frequent reasons for cancellation were lack of bed (50.0%) and patient unfit for anesthesia (15.2%) in DMCSH. The rest (34.8%) causes of cancellation in DMCSH included NPO time of the patient, no availability of surgical equipment, delayed lab result, the surgeon not available, patient refusal, patient on medication, no need for surgery, acute medical illness, patient requires other surgical work up, no availability of OR time, anesthetist not available and others. General surgery had the highest number, 100 (49.0%) of canceled cases in DMCSH (table 2) However, ENT surgery had the lowest 2 (1.0%) cancellation rate in DMCSH. The most common reason for the cancellation of elective General surgical cases was the lack of beds in DMCSH. Table 1. The percent of operation cancellation by age and sex at, Debre Markos Comprehensive Specialized Hospital, Debre Markos , Ethiopia, 2022GC. Sex of the patient Total Male Female Age of the patient 60 33 14 47 General surgery had the highest number, 100 (49.0%) of cancelled cases, however, ENT surgery had the lowest 2 (1.0%) cancellation rate in DMCSH (Table 2). Table: 2. Distribution of cancelled patients by planned procedure of elective surgery in Debre Markos Comprehensive Specialized Hospital, Debre Markos , Ethiopia, 2022GC . Valid Frequency Percent General surgery 100 49.0 Gyne and Obs 41 20.1 Orthopedics 44 21.6 ENT SURGERY 2 1.0 Pediatrics Surgery 17 8.3 Total 204 100.0 The rest (34.8%) causes of cancellation in DMCSH included NPO time of the patient, no availability of surgical equipment, delayed lab result, the surgeon not available, patient refusal, patient on medication, no need for surgery, acute medical illness, patient requires other surgical work up, no availability of OR time, anesthetist not available and others in (Table 3). Table: 3. Reasons for cancellations of Scheduled elective surgical cases in Debre Markos Comprehensive Specialized Hospital, Debre Markos , Ethiopia, 2022GC . Patient related Frequency Percent Patient refusal 9 4.4 Unfit for surgery 2 1.0 No need of surgery 2 1.0 Acute medical illness 3 1.5 NPO time of the patient 8 3.9 Total 24 11.8 The most common reason for cancellation of elective General surgical cases was lack of bed in DMCSH. Table: 4 Administration related of patient cancellation in Debre Markos Comprehensive Specialized Hospital, Debre Markos , Ethiopia, 2022G C. Administration related Frequey Percent No availability of or time 2 1.0 No availability of surgical equipment 25 12.3 Lack of bed 102 50.0 Delayed preparation of lab test 5 2.5 Others 9 4.4 Total 143 70.1 Patient unfit for anesthesia was (15.2%) in (Table 5). Table: 5 Anesthesia related of patient cancellation in Debre Markos Comprehensive Specialized Hospital, Debre Markos , Ethiopia, 2022G C. Anesthesia related Frequency Percent Patient unfit for anesthesia 31 15 Discussion This four-month hospital-based prospective study showed that about 26.7% of elective surgical cases were canceled in Debre Markos Comprehensive Specialized Hospital, Debre Markos, Ethiopia, 2022 G C. The most frequent reason for cancellation of these elective surgical cases was lack of beds. A cancellation rate of 26.7% for elective surgery found in DMCSH was very high. The reasons for cancellation were lack of beds (50.0%) and patients unfit for anesthesia (15.2%) in DMCSH were the most frequent reasons for cancellation of these elective surgical procedures. In this research, we found that most cancellations were followed by general surgery (49.0%) and orthopedic surgery (21.6%) in DMCSH. Our study result is similar to the following; Study conducted in Saudi Arabia the most common cause of patient cancellation was surgery-related factors and administrative factors with a similar percentage rate(34%) and the least factor was anesthesia-related (0%) (10). In a study was conducted in South Africa cancellations were related to equipment (47.4%), and 2.8% of cancellations were due to a long preceding surgical procedure (11). In this study similar to a retrospective cross-sectional observational study, selecting all patients scheduled for surgery at the hospital institution in Colombia the causes of cancellation, 93 (38.1%) were attributable to the institution, 99 (40.6) to patients, and 52 (21.3%) to medical orders (12) cancellation records of all elective surgeries scheduled between June 1, 2012, and Jan. 31, 2016, at a medium-sized, tertiary care, academic center in Malawi were retrospectively reviewed. Across 11 surgical specialties, 2933 of 20 881 surgeries (14.0%) were cancelled and of these, 2448 (83.5%) were for administrative or structural reasons (13). Our study finding is similar to a prospective cross-sectional study that was conducted at Jimma university medical center a total of 454 patients were scheduled to undergo elective surgical procedures, and of this92 patients’ procedures were cancelled. The majority of causes of cancellation of surgical operations were related to hospital administration in47.83% (14). In this study contrast to the studies conducted in Nigeria (15), Uganda (16), Brazil (17) and University of Gondar (18) were contrast with the result of our study. This reason may be infera structure recourses available and good administrative in those hospitals set up. . Conclusion and Recommendation The cancellation rate of scheduled surgeries is high in general adult surgery in DMCSH. The majority of causes are foreseeable and avoidable and many are related to the hospital itself. We recommend that a facility for hospital preadmission be created. Some measures are needed to reduce the case cancellation rate and to improve operation theatre utilization, including comprehensive preoperative assessment of patients before scheduling, making patients more aware of the planned surgical procedure, and preparing them before the operation Abbreviations ASA American society of anesthesiologist DMU Debre Markos University DMCSH Debre Markos Comprehensive Specialized Hospital OR Operation Room OT Operation Theatre Declarations Data Availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Ethical Approval and Consent Ethical clearance was obtained from the department ethical clearance committee college of health science department of anesthesia Debre Markos University before the start of the study. Get permission from DMCSH clinical director's office after submission of an official letter. The importance of the study was explained and written informed consent was obtained from each participant relative by the data collector. Participant’s involvement in the study was on voluntary bases, participants who were not willing to participate in the study & those who wish to quit their participation at any stage were informed to do so without any restriction. Conflicts of interest The authors declare no conflicts of interest Funding This research did not receive any specific grant from funding agencies. Authors’ contributions All authors should have made substantial contributions to all of the following: the conception and design of the study, or acquisition of data, drafting the article or revising it critically for important intellectual content, final approval of the version to be submitted. Acknowledgment. The authors thank Debre Markos University, college of medicine and health science for the support. Our heartfelt thanks also go to all the data collectors for their valuable contribution to the realization of this study. References Cause and incidence of Cancellation of elective surgeries at Gondar University hospital, Ethiopia. Yonas Addisu Nigatu, Habitu Adane Aytolign. 2020, research squar, pp. 1-10. Cancellation of surgery in patients attending the preoperative anaesthesia assessment clinic. Ahmed T, Khan M, Khan FA. JPMA The Journal of the Pakistan Medical Association : PubMed PMID, 2009. 19757703. Causes of cancellation of elective surgical operations at a univercity of teaching hospital. Ebirim LN,Buowari DY,Ezike H . s.l. : J Med Med Sci, 2012, Vol. 3. 5. Incidence, causes and pattern of cancellation of elective surgical operations. Chalya PL, Gilyoma JM, Mabula JB, Simbila S, Ngayomela IH, Chandika AB, et al. university teaching hospital in the Lake Zone, Tanzania : African health sciences, 2011. PubMed PMID: 22275936. A new pathway for elective surgery to reduce cancellation rates. Hovlid E, Bukve O, Haug K, Aslaksen AB, von Plessen C. s.l. : BMC health services research, 2012. PubMed PMID 22686475. Anaesthetic reasons for cancellation of elective surgical inpatients on the day of surgery. Hussain AM, Khan FA. s.l. : JPMA The Journal of the Pakistan Medical Association, 2005. PubMed PMID: 16302470.. Surgery cancelling at a teaching hospital: implications for cost management. Perroca MG, Jerico Mde C, Facundin SD. s.l. : Revista latino-americana de enfermagem, 2007. PubMed PMID: 18157457. Reasons for cancellation of operation on the day of intended surgery . Kumar R, Gandhi R. s.l. : Journal of anaesthesiology, clinical pharmacology, 2012. PubMed PMID: 22345949. Are elective surgical operstions cancelled due to increasing medical admission. Robb WB,O Sulliuan MJ,Brannigan AE, Bouchier-Hayes DJ. Irish : Pub Med, 2004. 129. Cancellation of elective surgeries in a Brazilian public hospital: reasons and estimated reduction. Rua Dr. Diogo de Faria, Vila Clementino . 2017, copy, p. 1_12. Cancellation of elective surgery: rates, reasons and effect on patient satisfaction. Rachel Phelan, MSc, Wilma M. Hopman, MA, and Dale Engen, MD. s.l. : Canadian journal of surgery, 2021. PMC8064262. Incidence and root causes of cancellations for elective orthopedic procedures . Ulla Caesar,Jon Karlsson,Lars-Eric Olsson,Kristian Samuelsson . sweden : BMC, 2014. 24. Cancellation of elective surgeries in a Brazilian public hospital: reasons and estimated reduction. Gisele Aparecida Alves Corral dos Santos, Silvia Cristina Mangini Bocchi. 2017, scielo brazil, p. 1_15. Incidences and Causes of Surgery Cancellation in a University Hospital in Barranquilla, Colombia, in 2016. Brayan Domínguez-Lozano1, Gisella Ortega-Crespo1, Anderson Díaz-Pérez1, Andrea Broullón Dobarro2. 2016, enfermeria global, pp. 1-11. Causes for cancellation of elective surgical procedure. Nabeel Sultan,Abdul Rashid,Syed M . Abbas : s.n., 2012, Vol. 24. 01. Cancellation of elective surgery: rates, reasons and effect on patient satisfaction. Wan Xian Koh, Rachel Phelan, Wilma M. Hopman, Dale Engen. 2021, canadian journal of surgery, p. go to. Cancellation of elective surgical procedure . Martin lankonde, P Bonkoungo, SIS Traore, RAF Kaborew . Johannsburg : south africa journal mos anesthesia and analgesia, 2016, Vol. 22. 5. Prevalence and Predictors of Cancellation of Elective Surgical Procedures at a Tertiary Hospital in Uganda:. Alfred Ogwal, Felix Oyania, Emmanuel Nkonge, Timothy Makumbi, Moses Galukande. 2020, hindawi, pp. 1-7. Reasons of cancellatioon of elective surgery. Kolawole IK,Bolaji BO. Ilorin : Nig J surg, 2002. 4(1-2). To assess the rationale of cancellation of surgical patients for elective surgery and length of hospital stay at Jimma University Medical Centre, Oromia Region, Ethiopia. Vinod V Bagilkar,Dheeraj Lamba,Markos Mehertab. jimma : Medical Science, 2019, Vol. 106. Cause and incidence of Cancellation of elective surgeries. Yonas Addisu Nigatu,Habitu Adane Aytolign. Gondar : research square, 2019. Incidences and Causes of Surgery Cancellation in a University Hospital in Barranquilla, Colombia, in 2016 . Brayan Domínguez-Lozano1 Gisella Ortega-Crespo1Anderson Díaz-Pérez1Andrea Broullón Dobarro2. 2016, enfermeria global, pp. 1-11. Day of surgery cancellations after nurse-led preassessment in an elective surgical centre. M. R. Rai and J. J. Pandit. s.l. : hindawi, 2003. Reasons for cancellation of cases on the day of surgery . Garg R, Bhalotra Ar, Bhadoria P, Grupta N, Anand R. new delhi : Indian journal of anesthesia , 2009. 53. Cancellation of elective surgical procedures. Martin Lankoanade,P Bonkoungou, SIS Traore, RAF Kabore,E Ouangre and Pendeville. Johannsburg : south as, 2016. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3887189","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":268666976,"identity":"0d09cf99-9ba0-443c-ab81-85a7f3910fa7","order_by":0,"name":"Yitayal Guadie","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA00lEQVRIiWNgGAWjYJACCQYDBgZ+ECuhgHgtBgySDSAtBkRrAVpjcADEJEaLfETyw9s8BX8SN59fnfjhgQGDPL/YAfxaDG+kGVvzGBgkbrvxdrME0GGGM2cnENAyI8FMGqLl7AaQlgSD2wS1pH8Da9k84+zmH0RpkZfIgdiygb93G3G2GPC8KbacY2BsPOMG7zaLBAMJwn6Rb0/feOPNHznZ/v6zm2/+qLCR55cmZMsBBgYmHhBLAqxSAr9ysC0NDAyMP0As/gOEVY+CUTAKRsHIBABWbEP2binVmgAAAABJRU5ErkJggg==","orcid":"","institution":"Debre Markos University","correspondingAuthor":true,"prefix":"","firstName":"Yitayal","middleName":"","lastName":"Guadie","suffix":""},{"id":268666977,"identity":"1228869c-e7f9-4291-81d8-6e945ec0119b","order_by":1,"name":"Yohannes Godie","email":"","orcid":"","institution":"Dilla University","correspondingAuthor":false,"prefix":"","firstName":"Yohannes","middleName":"","lastName":"Godie","suffix":""},{"id":268666978,"identity":"0eb2cf2d-c47a-4778-9654-fb4634a72742","order_by":2,"name":"Dires Birhanu","email":"","orcid":"","institution":"Dilla University","correspondingAuthor":false,"prefix":"","firstName":"Dires","middleName":"","lastName":"Birhanu","suffix":""}],"badges":[],"createdAt":"2024-01-22 07:18:00","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3887189/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3887189/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":50119457,"identity":"cd03da13-e311-4e31-9a29-74da7417b07d","added_by":"auto","created_at":"2024-01-24 19:26:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":109013,"visible":true,"origin":"","legend":"\u003cp\u003eBar graph of age and sex of rate of cancellation at Debre Markos Comprehensive Specialized Hospital, Debre Markos , Ethiopia, 2022GC .\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-3887189/v1/c55154244654b06c550277ef.png"},{"id":50119458,"identity":"d5f092ab-e76c-45eb-adff-84038198e937","added_by":"auto","created_at":"2024-01-24 19:26:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":247324,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of cancelled patients in Debre Markos Comprehensive Specialized Hospital, Debre Markos , Ethiopia,2022 GC.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-3887189/v1/6f4db4a607a5751f41842519.png"},{"id":50119456,"identity":"49763106-c551-4650-95a4-9cbe51233f5c","added_by":"auto","created_at":"2024-01-24 19:26:44","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":32208,"visible":true,"origin":"","legend":"\u003cp\u003ePatient related cause of cancellation in Debre Markos Comprehensive Specialized Hospital, Debre Markos , Ethiopia, 2022G C .\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-3887189/v1/d59ddd310f64f37d8b73f8cb.png"},{"id":50119478,"identity":"c123ddf2-9397-48f9-9ef3-7b371c799762","added_by":"auto","created_at":"2024-01-24 19:26:45","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":34304,"visible":true,"origin":"","legend":"\u003cp\u003eAdministrative factor of patient cancellation in Debre Markos Comprehensive Specialized Hospital, Debre Markos , Ethiopia, 2022G C .\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-3887189/v1/fd5191efdc8c7e99928785e1.png"},{"id":50121156,"identity":"bfba2d1c-851c-411c-821f-a2b7d9d9a177","added_by":"auto","created_at":"2024-01-24 19:42:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":898816,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3887189/v1/931bb40d-bf80-4f07-a814-a8554b902471.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eThe Incidence and Associated Factors of Patient Cancellation Scheduled for Elective Surgery From February to May at Debremarkos Comprehensive Spetialized Hospital, Debremarkos, Northwest Ethiopia, 2022 Gc. A Cross Sectional Study\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe advantages of preoperative patient assessment before the surgery are to optimize the medical condition of the patient before the surgical procedure, improve patient safety and satisfaction, reduction of resources in terms of preoperative medical consultation, and laboratory investigations, and reduce the length of hospital stay (2). Cancellation of elective operation on the intended day of surgery is considered when the patient\u0026rsquo;s name has appeared on the list for surgical operations but the operation was not done on the intended scheduled date (3). The operation theatre (OT) has been reported to be the heart of a hospital requiring considerable human resources and expenditure from the hospital budget (4). Most hospitals in developed countries invest considerable resources in maintaining operating suites and having surgeons and theatre staff available on an agreed schedule. However, in developing countries where resources are limited, cancellation of elective surgical operations due to various preventable reasons is a common phenomenon in most hospitals. It is well recognized that cancellation of patients from elective theatre operating lists increases cost, decreases efficiency, duplicates workload, and wastes operating room tim (5).\u003c/p\u003e \u003cp\u003eCancellation of elective surgical procedures causes significant emotional trauma to the patient as well as their families and the community. It is recognized that the cancellation of patients from elective operation increases cost, decreases efficiency, duplicates workload, and wastes operating room time (6). Elective surgery cancellation always leads to insufficient utilization of manpower and hospital resource and can also lead to an increase in patients' treatment expenses due to prolonged hospital stay and in many cases, repetition of preoperative preparation and management (7). The incidence of cancellation of elective surgical operations has been reported in the literature to range from 20\u0026ndash;40%. The causes of cancellation of elective surgical procedures are multifactorial and they tend to vary from one hospital to another (8).In general, its impact on hospital resources is great due to prolonged hospitalization and the high cost of health care (9). Generally, this study aimed to analyze the frequency, associated factors, and trend of cancellation of elective surgery operations in our environment and to identify the appropriate solutions for better patient management.\u003c/p\u003e"},{"header":"Methods and Materials","content":"\u003cp\u003eStudy area, design and Study period\u003c/p\u003e \u003cp\u003eA hospital-based Prospective cross-sectional study was conducted in the Amhara region, East Gojam Debre Markos Comprehensive Specialized Hospital on patients who were scheduled for elective surgery from February 01 to April 30, 2022 GC.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSource and Study of Populations\u003c/h2\u003e \u003cp\u003eAll elective patients appointed for major surgery at DMCSH from February 01 \u0026ndash; May 13, 2022, GC and all patients canceled from their elective surgery in surgical, obstetrics and gynecology, pediatrics and child health, and ophthalmic ward at DMCSH from February 01 \u0026ndash; May 13, 2022, GC.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eInclusion criteria and Exclusion criteria\u003c/h2\u003e \u003cp\u003eAll Patients scheduled for elective surgery at DMCSH from February 01 \u0026ndash; May 13, 2022, GC and data without full information, Patients scheduled in minor OR, and Patients who are operated on emergency.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSample size determination and sampling procedure\u003c/h2\u003e \u003cp\u003eA single population proportion formula, [n= (Z a/2)\u003csup\u003e2\u003c/sup\u003e p (1-p)/W\u003csup\u003e2\u003c/sup\u003e], is used to estimate the sample size to be included in the study. Due to lack of similar study about the cause and incidence of patient cancellation scheduled for elective surgery, a 50% is used for sample size determination by considering the following assumptions;\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e95% confidence interval,\u003c/p\u003e\u003cp\u003eMarginal error of 5%\u003c/p\u003e\u003cp\u003eThe sample size is determined by using 95% level of confidence (z\u0026thinsp;=\u0026thinsp;1.96), 50% as probability of success (p\u0026thinsp;=\u0026thinsp;0.5), 50% probability of failure (q\u0026thinsp;=\u0026thinsp;1-p\u0026thinsp;=\u0026thinsp;0.5), and 0.05 as margin error i.e d\u0026thinsp;=\u0026thinsp;0.05\u003c/p\u003e\u003cp\u003ed\u0026thinsp;=\u0026thinsp;Z \u003csub\u003ea/2\u003c/sub\u003e (p q/n)\u003csup\u003e1/2\u003c/sup\u003e\u003c/p\u003e\u003cp\u003en= (Z \u003csub\u003ea/2\u003c/sub\u003e )\u003csup\u003e2\u003c/sup\u003e *(p q)/d\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003cp\u003en=(1.96)\u003csup\u003e2\u003c/sup\u003e * (0.5*0.5)/(0.05)\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;384\u003c/p\u003e\u003cp\u003e, since N\u0026thinsp;\u0026lt;\u0026thinsp;10,000, Where N\u0026thinsp;=\u0026thinsp;study population (Biostatics, eighth edition, page 194).\u003c/p\u003e\u003cp\u003enf\u0026thinsp;=\u0026thinsp;ni/1+(ni/N)\u003c/p\u003e\u003cp\u003enf\u0026thinsp;=\u0026thinsp;384/1+(384/1055)\u0026thinsp;=\u0026thinsp;282\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStudy variables\u003c/h2\u003e \u003cp\u003eThe dependent variable is those patients cancelled from elective surgery and the independent variable is Socio-demographic factors, planned procedure, Availability of surgical equipment.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData collection tool and procedures\u003c/h2\u003e \u003cp\u003eThe data were collected using a structured questionnaire. The questionnaire is developed in English version by revising literature from previous similar studies and several questions that address the objective of the study were developed. The data was collected by three-fourth and two third-year anesthesia students after being given adequate training.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData Quality Assurance and Data Management\u003c/h2\u003e \u003cp\u003eThe two-day training was given about the data collection procedure for those data collectors and supervisors regarding the study purpose, how to conduct the interview, how to administer the questionnaire, how to give consent, keep confidentiality, and respect the rights of the participant.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eData processing and analysis\u003c/h2\u003e \u003cp\u003eThe data was processed and analyzed using SPPS version 20. The data was interpreted using descriptive statistics computed to determine frequency and percentage. The result will be presented by tables, bar graphs, and pie charts.\u003c/p\u003e \u003c/div\u003e"},{"header":"Result","content":"\u003cp\u003eDuring the study period 204 of the patients had their surgery cancelled for various reasons in Debre Markos Comprehensive Specialized Hospital. Reasons for cancellation are summarized in (table 2) for DMCSH. The two most frequent reasons for cancellation were lack of bed (50.0%) and patient unfit for anesthesia (15.2%) in DMCSH. The rest (34.8%) causes of cancellation in DMCSH included NPO time of the patient, no availability of surgical equipment, delayed lab result, the surgeon not available, patient refusal, patient on medication, no need for surgery, acute medical illness, patient requires other surgical work up, no availability of OR time, anesthetist not available and others.\u003c/p\u003e\n\u003cp\u003eGeneral surgery had the highest number, 100 (49.0%) of canceled cases in DMCSH (table 2) However, ENT surgery had the lowest 2 (1.0%) cancellation rate in DMCSH. The most common reason for the cancellation of elective General surgical cases was the lack of beds in DMCSH.\u003c/p\u003e\n\u003cp\u003eTable 1.\u0026nbsp;The percent of operation cancellation by age and sex at, Debre Markos Comprehensive Specialized Hospital, Debre Markos , Ethiopia, 2022GC.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"372\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.89247311827957%\" colspan=\"2\" rowspan=\"2\" valign=\"top\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"36.82795698924731%\" colspan=\"2\" valign=\"top\"\u003eSex of the patient\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.27956989247312%\" rowspan=\"2\" valign=\"top\"\u003eTotal\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003eMale\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003eFemale\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.997304582210244%\" rowspan=\"4\" valign=\"top\"\u003eAge of the patient\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"14.016172506738544%\" valign=\"top\"\u003e\u0026lt;20\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.328840970350406%\" valign=\"top\"\u003e21\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.328840970350406%\" valign=\"top\"\u003e4\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.328840970350406%\" valign=\"top\"\u003e25\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.3125%\" valign=\"top\"\u003e20-40\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"26.5625%\" valign=\"top\"\u003e30\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"26.5625%\" valign=\"top\"\u003e48\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"26.5625%\" valign=\"top\"\u003e78\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.3125%\" valign=\"top\"\u003e41-60\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"26.5625%\" valign=\"top\"\u003e24\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"26.5625%\" valign=\"top\"\u003e30\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"26.5625%\" valign=\"top\"\u003e54\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.3125%\" valign=\"top\"\u003e\u0026gt;60\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"26.5625%\" valign=\"top\"\u003e33\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"26.5625%\" valign=\"top\"\u003e14\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"26.5625%\" valign=\"top\"\u003e47\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eGeneral surgery had the highest number, 100 (49.0%) of cancelled cases, however, ENT surgery had the lowest 2 (1.0%) cancellation rate in DMCSH (Table 2).\u003c/p\u003e\n\u003cp\u003eTable: 2. Distribution of cancelled patients by \u003cstrong\u003eplanned procedure of elective surgery\u003c/strong\u003e in Debre Markos Comprehensive Specialized Hospital, Debre Markos , Ethiopia, 2022GC .\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"505\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"5\" valign=\"top\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.26732673267327%\" colspan=\"2\" valign=\"top\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Valid\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"20.99009900990099%\" valign=\"top\"\u003eFrequency\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.831683168316832%\" valign=\"top\"\u003ePercent\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"28.91089108910891%\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.702970297029703%\" rowspan=\"6\" valign=\"top\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"23.564356435643564%\" valign=\"top\"\u003eGeneral surgery\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"20.99009900990099%\" valign=\"top\"\u003e100\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.831683168316832%\" valign=\"top\"\u003e49.0\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"28.91089108910891%\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.096491228070175%\" valign=\"top\"\u003eGyne and Obs\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"23.24561403508772%\" valign=\"top\"\u003e41\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.640350877192983%\" valign=\"top\"\u003e20.1\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"32.01754385964912%\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.096491228070175%\" valign=\"top\"\u003eOrthopedics\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"23.24561403508772%\" valign=\"top\"\u003e44\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.640350877192983%\" valign=\"top\"\u003e21.6\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"32.01754385964912%\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.096491228070175%\" valign=\"top\"\u003eENT SURGERY\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"23.24561403508772%\" valign=\"top\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.640350877192983%\" valign=\"top\"\u003e1.0\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"32.01754385964912%\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.096491228070175%\" valign=\"top\"\u003ePediatrics Surgery\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"23.24561403508772%\" valign=\"top\"\u003e17\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.640350877192983%\" valign=\"top\"\u003e8.3\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"32.01754385964912%\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.096491228070175%\" valign=\"top\"\u003eTotal\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"23.24561403508772%\" valign=\"top\"\u003e204\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.640350877192983%\" valign=\"top\"\u003e100.0\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"32.01754385964912%\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe rest (34.8%) causes of cancellation in DMCSH included NPO time of the patient, no availability of surgical equipment, delayed lab result, the surgeon not available, patient refusal, patient on medication, no need for surgery, acute medical illness, patient requires other surgical work up, no availability of OR time, anesthetist not available and others in (Table 3).\u003c/p\u003e\n\u003cp\u003eTable: 3. Reasons for cancellations of Scheduled elective surgical cases in Debre Markos Comprehensive Specialized Hospital, Debre Markos , Ethiopia, 2022GC\u0026nbsp;.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"548\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.503649635036496%\" colspan=\"2\" valign=\"top\"\u003ePatient related\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.43065693430657%\" valign=\"top\"\u003eFrequency\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"13.86861313868613%\" valign=\"top\"\u003ePercent\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"29.197080291970803%\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.496350364963504%\" rowspan=\"6\" valign=\"top\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"27.00729927007299%\" valign=\"top\"\u003ePatient refusal\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.43065693430657%\" valign=\"top\"\u003e9\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"13.86861313868613%\" valign=\"top\"\u003e4.4\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"29.197080291970803%\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.515463917525775%\" valign=\"top\"\u003eUnfit for surgery\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"20.824742268041238%\" valign=\"top\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\" valign=\"top\"\u003e1.0\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"32.98969072164948%\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.515463917525775%\" valign=\"top\"\u003eNo need of surgery\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"20.824742268041238%\" valign=\"top\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\" valign=\"top\"\u003e1.0\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"32.98969072164948%\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.515463917525775%\" valign=\"top\"\u003eAcute medical illness\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"20.824742268041238%\" valign=\"top\"\u003e3\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\" valign=\"top\"\u003e1.5\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"32.98969072164948%\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.515463917525775%\" valign=\"top\"\u003eNPO time of the patient\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"20.824742268041238%\" valign=\"top\"\u003e8\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\" valign=\"top\"\u003e3.9\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"32.98969072164948%\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.515463917525775%\" valign=\"top\"\u003eTotal\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"20.824742268041238%\" valign=\"top\"\u003e24\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.670103092783505%\" valign=\"top\"\u003e11.8\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"32.98969072164948%\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe most common reason for cancellation of elective General surgical cases was lack of bed in DMCSH.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable: 4\u0026nbsp;\u003c/strong\u003eAdministration related of patient cancellation in Debre Markos Comprehensive Specialized Hospital, Debre Markos , Ethiopia, 2022G C.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"414\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"54.72154963680387%\" colspan=\"2\" valign=\"top\"\u003e\u003cstrong\u003eAdministration related \u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.64406779661017%\" valign=\"top\"\u003eFrequey\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"26.634382566585955%\" valign=\"top\"\u003ePercent\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"4.5893719806763285%\" rowspan=\"6\" valign=\"top\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"50.24154589371981%\" valign=\"top\"\u003eNo availability of or time\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"18.59903381642512%\" valign=\"top\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"26.570048309178745%\" valign=\"top\"\u003e1.0\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.65822784810127%\" valign=\"top\"\u003eNo availability of surgical equipment\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.49367088607595%\" valign=\"top\"\u003e25\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"27.848101265822784%\" valign=\"top\"\u003e12.3\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.65822784810127%\" valign=\"top\"\u003eLack of bed\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.49367088607595%\" valign=\"top\"\u003e102\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"27.848101265822784%\" valign=\"top\"\u003e50.0\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.65822784810127%\" valign=\"top\"\u003eDelayed preparation of lab \u0026nbsp;test\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.49367088607595%\" valign=\"top\"\u003e5\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"27.848101265822784%\" valign=\"top\"\u003e2.5\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.65822784810127%\" valign=\"top\"\u003eOthers\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.49367088607595%\" valign=\"top\"\u003e9\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"27.848101265822784%\" valign=\"top\"\u003e4.4\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.65822784810127%\" valign=\"top\"\u003eTotal\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.49367088607595%\" valign=\"top\"\u003e143\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"27.848101265822784%\" valign=\"top\"\u003e70.1\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ePatient unfit for anesthesia was \u0026nbsp;(15.2%) in (Table 5).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable: 5\u0026nbsp;\u003c/strong\u003eAnesthesia related of patient cancellation in Debre Markos Comprehensive Specialized Hospital, Debre Markos , Ethiopia, 2022G C.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"572\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.93706293706294%\" colspan=\"2\" valign=\"top\"\u003e\u003cstrong\u003eAnesthesia related\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.783216783216783%\" valign=\"top\"\u003eFrequency\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\" valign=\"top\"\u003ePercent\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"26.04895104895105%\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.739965095986038%\" valign=\"top\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"25.305410122164048%\" valign=\"top\"\u003ePatient unfit for anesthesia\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.75392670157068%\" valign=\"top\"\u003e31\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"19.19720767888307%\" valign=\"top\"\u003e15\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"26.00349040139616%\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis four-month hospital-based prospective study showed that about 26.7% of elective surgical cases were canceled in Debre Markos Comprehensive Specialized Hospital, Debre Markos, Ethiopia, 2022 G C. The most frequent reason for cancellation of these elective surgical cases was lack of beds. A cancellation rate of 26.7% for elective surgery found in DMCSH was very high. The reasons for cancellation were lack of beds (50.0%) and patients unfit for anesthesia (15.2%) in DMCSH were the most frequent reasons for cancellation of these elective surgical procedures. In this research, we found that most cancellations were followed by general surgery (49.0%) and orthopedic surgery (21.6%) in DMCSH.\u003c/p\u003e \u003cp\u003eOur study result is similar to the following; Study conducted in Saudi Arabia the most common cause of patient cancellation was surgery-related factors and administrative factors with a similar percentage rate(34%) and the least factor was anesthesia-related (0%) (10). In a study was conducted in South Africa cancellations were related to equipment (47.4%), and 2.8% of cancellations were due to a long preceding surgical procedure (11).\u003c/p\u003e \u003cp\u003eIn this study similar to a retrospective cross-sectional observational study, selecting all patients scheduled for surgery at the hospital institution in Colombia the causes of cancellation, 93 (38.1%) were attributable to the institution, 99 (40.6) to patients, and 52 (21.3%) to medical orders (12) cancellation records of all elective surgeries scheduled between June 1, 2012, and Jan. 31, 2016, at a medium-sized, tertiary care, academic center in Malawi were retrospectively reviewed. Across 11 surgical specialties, 2933 of 20 881 surgeries (14.0%) were cancelled and of these, 2448 (83.5%) were for administrative or structural reasons (13).\u003c/p\u003e \u003cp\u003eOur study finding is similar to a prospective cross-sectional study that was conducted at Jimma university medical center a total of 454 patients were scheduled to undergo elective surgical procedures, and of this92 patients’ procedures were cancelled. The majority of causes of cancellation of surgical operations were related to hospital administration in47.83% (14).\u003c/p\u003e \u003cp\u003eIn this study contrast to the studies conducted in Nigeria (15), Uganda (16), Brazil (17) and University of Gondar (18) were contrast with the result of our study. This reason may be infera structure recourses available and good administrative in those hospitals set up.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003cp\u003e.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion and Recommendation","content":"\u003cp\u003eThe cancellation rate of scheduled surgeries is high in general adult surgery in DMCSH. The majority of causes are foreseeable and avoidable and many are related to the hospital itself.\u003c/p\u003e\u003cp\u003eWe recommend that a facility for hospital preadmission be created. Some measures are needed to reduce the case cancellation rate and to improve operation theatre utilization, including comprehensive preoperative assessment of patients before scheduling, making patients more aware of the planned surgical procedure, and preparing them before the operation\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eASA American society of anesthesiologist\u003c/p\u003e\n\u003cp\u003eDMU Debre Markos University\u003c/p\u003e\n\u003cp\u003eDMCSH Debre Markos Comprehensive Specialized Hospital\u003c/p\u003e\n\u003cp\u003eOR Operation Room\u003c/p\u003e\n\u003cp\u003eOT Operation Theatre\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e Ethical Approval and \u003c/strong\u003e\u003cstrong\u003eConsent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance was obtained from the department ethical clearance committee college of health science department of anesthesia Debre Markos University before the start of the study. Get permission from DMCSH clinical director\u0026apos;s office after submission of an official letter. The importance of the study was explained and written informed consent was obtained from each participant relative by the data collector. Participant\u0026rsquo;s involvement in the study was on voluntary bases, participants who were not willing to participate in the study \u0026amp; those who wish to quit their participation at any stage were informed to do so without any restriction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e Conflicts of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors should have made substantial contributions to all of the following: the conception and design of the study, or acquisition of data, drafting the article or revising it critically for important intellectual content, final approval of the version to be submitted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank Debre Markos University, college of medicine and health science for the support. Our heartfelt thanks also go to all the data collectors for their valuable contribution to the realization of this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e\u003cem\u003eCause and incidence of Cancellation of elective surgeries at Gondar University hospital, Ethiopia. \u003c/em\u003e\u003cstrong\u003eYonas Addisu Nigatu, Habitu Adane Aytolign.\u003c/strong\u003e 2020, research squar, pp. 1-10.\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eCancellation of surgery in patients attending the preoperative anaesthesia assessment clinic. \u003c/em\u003e\u003cstrong\u003eAhmed T, Khan M, Khan FA.\u003c/strong\u003e JPMA The Journal of the Pakistan Medical Association : PubMed PMID, 2009. 19757703.\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eCauses of cancellation of elective surgical operations at a univercity of teaching hospital. \u003c/em\u003e\u003cstrong\u003eEbirim LN,Buowari DY,Ezike H .\u003c/strong\u003e s.l. : J Med Med Sci, 2012, Vol. 3. 5.\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eIncidence, causes and pattern of cancellation of elective surgical operations. \u003c/em\u003e\u003cstrong\u003eChalya PL, Gilyoma JM, Mabula JB, Simbila S, Ngayomela IH, Chandika AB, et al.\u003c/strong\u003e university teaching hospital in the Lake Zone, Tanzania : African health sciences, 2011. PubMed PMID: 22275936.\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eA new pathway for elective surgery to reduce cancellation rates. \u003c/em\u003e\u003cstrong\u003eHovlid E, Bukve O, Haug K, Aslaksen AB, von Plessen C.\u003c/strong\u003e s.l. : BMC health services research, 2012. PubMed PMID 22686475.\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eAnaesthetic reasons for cancellation of elective surgical inpatients on the day of surgery. \u003c/em\u003e\u003cstrong\u003eHussain AM, Khan FA.\u003c/strong\u003e s.l. : JPMA The Journal of the Pakistan Medical Association, 2005. PubMed PMID: 16302470..\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eSurgery cancelling at a teaching hospital: implications for cost management. \u003c/em\u003e\u003cstrong\u003ePerroca MG, Jerico Mde C, Facundin SD.\u003c/strong\u003e s.l. : Revista latino-americana de enfermagem, 2007. PubMed PMID: 18157457.\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eReasons for cancellation of operation on the day of intended surgery . \u003c/em\u003e\u003cstrong\u003eKumar R, Gandhi R.\u003c/strong\u003e s.l. : Journal of anaesthesiology, clinical pharmacology, 2012. PubMed PMID: 22345949.\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eAre elective surgical operstions cancelled due to increasing medical admission. \u003c/em\u003e\u003cstrong\u003eRobb WB,O Sulliuan MJ,Brannigan AE, Bouchier-Hayes DJ.\u003c/strong\u003e Irish : Pub Med, 2004. 129.\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eCancellation of elective surgeries in a Brazilian public hospital: reasons and estimated reduction. \u003c/em\u003e\u003cstrong\u003eRua Dr. Diogo de Faria, Vila Clementino .\u003c/strong\u003e 2017, copy, p. 1_12.\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eCancellation of elective surgery: rates, reasons and effect on patient satisfaction. \u003c/em\u003e\u003cstrong\u003eRachel Phelan, MSc, Wilma M. Hopman, MA, and Dale Engen, MD.\u003c/strong\u003e s.l. : Canadian journal of surgery, 2021. PMC8064262.\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eIncidence and root causes of cancellations for elective orthopedic procedures . \u003c/em\u003e\u003cstrong\u003eUlla Caesar,Jon Karlsson,Lars-Eric Olsson,Kristian Samuelsson .\u003c/strong\u003e sweden : BMC, 2014. 24.\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eCancellation of elective surgeries in a Brazilian public hospital: reasons and estimated reduction. \u003c/em\u003e\u003cstrong\u003eGisele Aparecida Alves Corral dos Santos, Silvia Cristina Mangini Bocchi.\u003c/strong\u003e 2017, scielo brazil, p. 1_15.\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eIncidences and Causes of Surgery Cancellation in a University Hospital in Barranquilla, Colombia, in 2016. \u003c/em\u003e\u003cstrong\u003eBrayan Dom\u0026iacute;nguez-Lozano1, Gisella Ortega-Crespo1, Anderson D\u0026iacute;az-P\u0026eacute;rez1, Andrea Broull\u0026oacute;n Dobarro2.\u003c/strong\u003e 2016, enfermeria global, pp. 1-11.\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eCauses for cancellation of elective surgical procedure. \u003c/em\u003e\u003cstrong\u003eNabeel Sultan,Abdul Rashid,Syed M .\u003c/strong\u003e Abbas : s.n., 2012, Vol. 24. 01.\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eCancellation of elective surgery: rates, reasons and effect on patient satisfaction. \u003c/em\u003e\u003cstrong\u003eWan Xian Koh, Rachel Phelan, Wilma M. Hopman, Dale Engen.\u003c/strong\u003e 2021, canadian journal of surgery, p. go to.\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eCancellation of elective surgical procedure . \u003c/em\u003e\u003cstrong\u003eMartin lankonde, P Bonkoungo, SIS Traore, RAF Kaborew .\u003c/strong\u003e Johannsburg : south africa journal mos anesthesia and analgesia, 2016, Vol. 22. 5.\u003c/li\u003e\n\u003cli\u003e\u003cem\u003ePrevalence and Predictors of Cancellation of Elective Surgical Procedures at a Tertiary Hospital in Uganda:. \u003c/em\u003e\u003cstrong\u003eAlfred Ogwal, Felix Oyania, Emmanuel Nkonge, Timothy Makumbi, Moses Galukande.\u003c/strong\u003e 2020, hindawi, pp. 1-7.\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eReasons of cancellatioon of elective surgery. \u003c/em\u003e\u003cstrong\u003eKolawole IK,Bolaji BO.\u003c/strong\u003e Ilorin : Nig J surg, 2002. 4(1-2).\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eTo assess the rationale of cancellation of surgical patients for elective surgery and length of hospital stay at Jimma University Medical Centre, Oromia Region, Ethiopia. \u003c/em\u003e\u003cstrong\u003eVinod V Bagilkar,Dheeraj Lamba,Markos Mehertab.\u003c/strong\u003e jimma : Medical Science, 2019, Vol. 106.\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eCause and incidence of Cancellation of elective surgeries. \u003c/em\u003e\u003cstrong\u003eYonas Addisu Nigatu,Habitu Adane Aytolign.\u003c/strong\u003e Gondar : research square, 2019.\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eIncidences and Causes of Surgery Cancellation in a University Hospital in Barranquilla, Colombia, in 2016 . \u003c/em\u003e\u003cstrong\u003eBrayan Dom\u0026iacute;nguez-Lozano1 Gisella Ortega-Crespo1Anderson D\u0026iacute;az-P\u0026eacute;rez1Andrea Broull\u0026oacute;n Dobarro2.\u003c/strong\u003e 2016, enfermeria global, pp. 1-11.\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eDay of surgery cancellations after nurse-led preassessment in an elective surgical centre. \u003c/em\u003e\u003cstrong\u003eM. R. Rai and J. J. Pandit.\u003c/strong\u003e s.l. : hindawi, 2003.\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eReasons for cancellation of cases on the day of surgery . \u003c/em\u003e\u003cstrong\u003eGarg R, Bhalotra Ar, Bhadoria P, Grupta N, Anand R.\u003c/strong\u003e new delhi : Indian journal of anesthesia , 2009. 53.\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eCancellation of elective surgical procedures. \u003c/em\u003e\u003cstrong\u003eMartin Lankoanade,P Bonkoungou, SIS Traore, RAF Kabore,E Ouangre and Pendeville.\u003c/strong\u003e Johannsburg : south as, 2016.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cancellation, Elective surgery, Debremarkos compherasive specialized hospital, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-3887189/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3887189/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHigh rates of cancellation of surgical procedures are common in hospital settings which may subsequently lead to economic loss to hospitals besides the burden given to patients, their families, and medical teams. It is well recognized that cancellation of patients from elective theatre operating lists increases cost, decreases efficiency, duplicates workload, and wastes operating room time. Cancellation of elective surgical procedures also causes significant emotional trauma to the patients as well as their families and the community in general, and its impact on hospital resources is great due to prolonged hospitalization and the high cost of health care (1). This study aimed to assess the incidence and causes of patient cancellation scheduled for elective surgery in Debre Markos Comprehensive Specialized Hospital., Debremarkos, Northwest Ethiopia, 2022 GC.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e \u003cstrong\u003eand Materials\u003c/strong\u003e: A prospective cross-sectional study was conducted on the cancellation of scheduled surgery at Debremarkos Comprehensive Specialized Hospital with a total of 282 sample size from February-01-May-13 consecutive months of 2022 G C. The data was collected from the operating room daily surgical schedule, preoperative anesthesia record sheet, primary physicians, and the anesthetist responsible for the preoperative assessment and conducting the case and by communicating patients if required. Analysis will be done by using SPSS (Version 20). Descriptive as well as analytic statistics are used for variables and data will be presented by tables, graphs, charts, and texts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult:\u003c/strong\u003e A total of 1055 patients were scheduled for elective Surgery in Debremarkos Comprehensive Specialized Hospital. During the study period 282(26.7%) of the patients had their surgery cancelled for various reasons in Debremarkos Comprehensive Specialized Hospital. The two most frequent reasons for cancellation were lack of bed (50.0%) and unfit for anesthesia (15.2%) in DMCSH.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion and Recommendation\u003c/strong\u003e: In conclusion, the cancellation rate of scheduled surgeries is high in general adult surgery at Debremarkos Comprehensive Specialized Hospital. The majority of causes are foreseeable and avoidable, and many are related to the hospital itself. We recommend that a facility for hospital preadmission be created.\u003c/p\u003e","manuscriptTitle":"The Incidence and Associated Factors of Patient Cancellation Scheduled for Elective Surgery From February to May at Debremarkos Comprehensive Spetialized Hospital, Debremarkos, Northwest Ethiopia, 2022 Gc. A Cross Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-24 19:26:39","doi":"10.21203/rs.3.rs-3887189/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c42514e3-6606-4930-b8fd-8a30be9ab46c","owner":[],"postedDate":"January 24th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-01-24T19:26:42+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-24 19:26:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3887189","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3887189","identity":"rs-3887189","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}