A study of elective surgery at 91 English NHS trusts has found that 10% of operations were cancelled the day before the planned surgery date, while 9% were postponed when patients attended their pre-operative appointment. If these findings were replicated across England, it would equate to approximately 300,000 cancellations or postponements annually.
Study reveals avoidable cancellations
Researchers from the National Institute for Health and Care Research Central London Patient Safety Research Collaboration, NHS England, University College London, and the Royal College of Anaesthetists examined planned surgery data over seven days in November 2024. They found that the most common causes of cancellations were medical reasons, patients not attending, operating lists overrunning, and emergency admissions. However, in 37.3% of cases, had these issues been identified three to five days earlier, the operation could have proceeded or another patient could have been offered the slot.
The study, published in the British Journal of Anaesthesia, also revealed that nearly two-thirds of operations postponed at the pre-op appointment were due to patients requiring further tests or specialist clinical review.
Call for clinical pathway overhaul
The authors concluded that clinical pathways need restructuring, with more early screening, nimbler surgery scheduling, and better communication. Lead author Dr. James Bedford of University College London stated: "We need to ensure we identify health problems that put patients at risk of post-operative complications as early as possible, so that these can be improved while they are waiting for their operation." He added that early screening also helps identify low-risk patients who could be offered surgery at short notice when slots become available.
In a linked editorial, Prof. Scarlett McNally, a consultant orthopaedic surgeon, said the findings "underscore the scale of systemic inefficiencies, unacceptable waste of public money, and emotional toll experienced by patients." She warned: "Without a different approach that focuses on supporting and preparing these patients, waiting lists will remain unacceptably high."
Impact on patients and NHS
Prof. Frank Smith, vice-president of the Royal College of Surgeons of England, said the study underlined how damaging cancellations are for patients and the NHS. He emphasized: "High-quality care before and after surgery is just as important as the operation itself. The findings underline the need for earlier, better coordinated care so patients are in the best possible condition when they reach the operating theatre." He noted that supporting patients to 'wait well' reduces last-minute cancellations, improves recovery, and helps the NHS use surgical capacity more effectively.
An NHS spokesperson commented: "We are seeing great examples of NHS teams across the country offering more personalised support to ensure patients are fit for surgery, and we need to continue and extend this progress to improve preoperative care for patients, eliminate avoidable postponements, and keep bringing waiting lists down."
The latest figures show that as of the end of February, just over 6 million patients were waiting for treatment in England.
