What are the reasons for last-minute cancellation or postponement of surgery?
The incidence of last-minute postponement or cancel-lation of ambulatory procedures exceeds the cancellation rate for the inpatient population. A multiplicity of factors can be operative. Repeat physical examination by the sur-geon may reveal the disappearance of pathology. Patients may forget and ingest either solid food or liquids before arrival at the medical facility. Abnormal results on tests that were not available or not previously reviewed may be discovered. Communication between the surgeon and anesthesiologist regarding laboratory abnormalities will help to reduce the incidence of last-minute cancellation of surgery, the consequences of which distress both patient and surgeon and make for inefficient use of available oper-ating room time. Additional questioning may reveal either new symptoms or significant history that was not previ-ously elicited. Physical findings apparent on a last-minute assessment by the anesthesiologist may preclude the safe administration of an anesthetic. Examples include an acute upper respiratory tract infection or an exacerbation of bronchospastic pulmonary disease. Finally, patients may arrive late to the facility or without a responsible escort to accompany them home.
Because the escort’s function in the postoperative period goes beyond merely ensuring a safe means of trans-portation home, in the absence of a designated appropriate escort, surgery should not proceed unless alternative care arrangements are made. If the patient speaks only a foreign language, the escort may serve as an interpreter through-out the perioperative period. After surgery, the escort will receive the postoperative instructions and serve as a com-panion to the patient during the first 24 hours following the completion of surgery. Assistance in the performance of activities of daily living will be rendered as required. Additionally, the escort will be available to summon medical assistance in the event of a medical, surgical, or anesthetic complication.