COVID-19 effects on operating room cancellations at a pediatric tertiary care hospital: A retrospective cohort study

Background: Same-day surgery cancellation results in decreased operating room (OR) utilization, reduced pro-ductivity, and inconvenience for patients. We aim to assess the cancellation rates of elective surgeries, identify common causes, and evaluate changes due to the COVID pandemic. Methods: A retrospective cohort study was conducted identifying all same-day surgery cancellations at a tertiary pediatric academic hospital from 1/1/2015 to 12/31/2017 (pre-COVID) and from 4/1/2020 to 3/31/2021 (post-COVID). Statistical analysis was performed using generalized regression with cancellation as the dependent variable. Period, age, ethnicity, gender, preferred language, and insurance were independent variables. Results: There were 55465 scheduled cases (41670 before and 13795 after COVID), with 1508 cancellations (2.7%). Of those, 1247 (3.0%) were before COVID and 261 (1.9%) after COVID (p < .001). Of all cases, 56.7% (31475) were male, 55.1% (30595) were non-Hispanic/Latinx whites, 82.3% (45638) spoke English, and 45.5% (25237) had public insurance. The mean age was 8.5 years (SD = 6.03).The decrease in the probability of cancellation was most significant in patients with public insurance, < 1 year -of-age, Hispanic/Latinx who spoke Spanish (pre-pandemic = 4.9% [CI = 4.2%-5.8%]; pandemic = 2.8% [95% CI = 1.9%-4.0%]. Regardless of the period, Hispanic/Latinx patients and those with public insurance had higher rates of surgery cancellations (p < .001). Conclusion: There was a significant decrease in same-day cancellations post-pandemic. We hypothesize that the required pre-operative COVID test helped to minimize same-day cancellations. Increased communication and education enhanced family engagement and was critical for improved OR metrics, including cancellation rates. Level of evidence: level IV.