Economic and psychological burden of scheduled surgery cancellation in a sub-Saharan country (Burkina Faso)

Abstract

Background: Cancellation of scheduled surgery creates a financial burden for hospitals, caregivers and patients. Cancellation causes emotional stress, which impacts on outcomes. In poor countries where the adequacy of healthcare is limited, the ethical dilemma created by scheduled surgery cancellation is particularly important.

Objective: To identify the incidence, cost and emotional impact of elective surgical cancellation in a teaching hospital in Burkino
Faso.

Methods: A four month, prospective, observational study was undertaken in a teaching hospital (Yalgado Ouedraogo). All surgical patients were eligible. The causes of cancellation, financial cost and patients’ emotional response were assessed. The cost was estimated using a tool adapted for the economic cost of African job types.

Results: During the study period, 1 088 cases were scheduled to undergo inpatient surgery. Of these, 239 cases (21.9%) were cancelled. Among the cancelled cases, 237 were cancelled during preparation in the surgical ward and two cases were cancelled in the operation room. A large number of the patients were housewives (n = 87). The highest cancellation rate (35.9%) was found in general surgery. Cancellation was judged avoidable in 214 cases (89.5%). The total cost of surgery cancellation to the hospital was US$ 19 147 (mean value US$ 80 per patient). Patients lost a mean of US$ 62.70, which represented 117.6% of the official average monthly income in Burkina Faso. ENT surgery was the costliest to the hospital (US$ 4 989 ). Cancellation caused a negative emotional reaction in 205 patients (85.7%) and ‘sadness’ was the most frequent (54.8%; n = 131). Cancellation resulted in 163 days of work lost.

Conclusion: Based on income, the cost of day of surgery cancellation was high in Burkina Faso.

Keywords: cost, emotional reaction, psychology, surgery cancellation