O1005: Cancellations in Congenital Heart Disease Surgery

Background: Short-term cancellation of surgical procedures has been demonstrated to negatively impact patient outcomes and increase healthcare costs. Although recognized as common, quantification of the frequency of cancellations in patients with congenital heart disease has not been previously described.

Methods: Patients with congenital heart disease scheduled for surgical repair at the University of Wisconsin from January of 2018 through December of 2023 were reviewed. For patients with multiple scheduled procedures, only the principal surgery was included. Subsequent non-cardiac procedures were excluded. Patients’ age at surgery and the STAT score (a measure of operative risk) were recorded. Cancellations were categorized into patient factors and institutional factors. Patient factors included viral illness, other illness, abnormal labs and additional imaging required. Institutional factors included emergent surgical case taking priority, no bed available, no surgeon available, no operating room available and insurance issues. Patients who had surgeries cancelled due to viral symptoms were counted as a viral illness, even if viral testing was not obtained. Patients with positive PCR and home antigen tests were considered confirmed COVID infections and other viral confirmations were confirmed with viral pathogen panel testing.

Results: A total of 729 cases were analyzed. Of these, 220 (30%) were cancelled with 145 (66%) cancelled due to patient factors and 68 (31%) cancelled due to institutional factors. The most common patient factor contributing to cancellation was a suspected or confirmed viral illness (69/145, 48%). The most common viral etiology for cancellation was rhinovirus (27/76, 36%), followed by SARS-COV-2 (17/76, 22%) with 15/76 (20%) symptomatic patients not having viral testing done. The most common institutional factor was an emergent case taking priority (33/68, 49%). As a single procedure may have been cancelled multiple times, the total number of cases scheduled (729) exceeds the total number of cases performed (682).

Unsurprisingly, cancellations were least common in neonates and STAT 5 procedures but were similar across all other age groups and STAT categories. Cancellations did not show a notable seasonal variation.

Conclusion: The most common cause for cancellation of a congenital heart disease surgeries is a viral illness. Although neonates and patients needing STAT 5 procedures were the least likely to be cancelled, the rate of cancellation was similar across the other age and STAT categories. In a cohort including the COVID 19 pandemic, there was no obvious seasonal variation in cancellations.