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

Aims:
Non-UK single centre studies report total knee replacement (TKR) cancellation rates of 5-23%; one UK study reports 26%. Many occur at short notice and for avoidable medical reasons. This negatively affects patient well-being and typically results in a lost NHS tariff of £6,500 to £11,000 per cancellation.

This study aimed to collect reasons for and timing of cancellation of TKR surgery at UKNHS hospitals.

Methods:
Routinely collected data TKR surgery cancellation were obtained from six NHS hospitals. Where reasons were not explicit, such as ‘patient unfit’, medical notes were consulted to establish the specific clinical reason. Data were coded into categories, compiled and analysed using descriptive statistics.

Results:
A total of 9403 cancellations occurred and 17,223 TKR procedures were performed at six NHS hospitals over five years (2018-2023). Variability in reporting between Trusts precludes certainty about incidence rates. Cancellation categories were institutional (56%, n=5283), clinical (19%, n=1794), and patient preference (24%, n=2286). Reasons were missing for 0.4% (n=40). Most occurred 2–14 days before surgery (60%, n=5659). A quarter occurred at short notice(25%, n=2390). Most short notice reasons were bed not available and ‘patient unfit’, with most clinical reasons being cardiac, infection, and wound.

Conclusion:
One in four TKR cancellations occur at short notice. Most reasons relate to bed availability and patients not being fit for surgery and are generalisable to other elective surgeries. There is an urgent need for targeted efficiency programmes and care pathways to prevent cancellations.