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Business of Medicine/Practice Management

(355) Otolaryngology Case Cancellation and Rescheduling Trends in the Covid-19 Era

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time

    Presenting Author(s)

  • DL

    Doreen W. Lam, BA

    Medical Student
    Perelman School of Medicine, University of Pennsylvania
    Philadelphia, PA, United States

    • Co-Author(s)

  • Saawan D. Patel, BBA

    Medical Student
    Perelman School of Medicine, University of Pennsylvania
    Philadelphia, Pennsylvania, United States

  • TW

    T. Peterson Wagner, BA

    Perelman School of Medicine, University of Pennsylvania, USA

  • Nithin D. Adappa, MD

    Associate Professor
    Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania
    Philadelphia, PA, United States

  • SC

    Steven B. B. Cannady, MD

    Associate Professor
    Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania
    Philadelphia, Pennsylvania, United States

  • Karthik Rajasekaran, MD

    Assistant Professor, Head and Neck Oncologic & Reconstructive Surgeon, Director of QI
    Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania
    Philadelphia, Pennsylvania, United States

    • Senior Author(s)

  • RB

    Robert M. Brody, MD

    Assistant Professor
    Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania
    Philadelphia, Pennsylvania, United States

Disclosure(s):
Saawan D. Patel, BBA: No relevant relationships to disclose.
Steven B. B. Cannady, MD: No relevant relationships to disclose.
Karthik Rajasekaran, MD: No relevant relationships to disclose.
Robert M. Brody, MD: No relevant relationships to disclose.


Introduction: Protective protocols helped restore surgical services after the Covid-19 pandemic began, but new SARS-COV2 variants continue to cause cancellations. Few studies have reported on case cancellation rates and rescheduling delays throughout the pandemic. Here, we summarize trends within ENT at a high-volume academic center.

Methods: A retrospective review of ENT surgeries scheduled between December 2019 and August 2022 was performed. Scheduling information and cancellation reasons were abstracted via EMR review, and cases categorized by calendar quarter based on original date. Analysis was performed in R.

Results: 14,162 cases met inclusion criteria. In the 15 weeks before March 15, 2020, the cancellation rate was 0.5%. From March 15 to 30, cancellations rose to 45% and remained elevated at 20% in Q2 2020. Cancellations declined to 0.5% by Q3 2021, before rising to 2.6% in Q1 2022 and declining to 0.8% by August 2022.

Between March and Q2 2020, 91% of cancellations were due to health system precautions. By Q4 2020, 24% were Covid-19 infection or exposure related, declining to 13% in Q3 2021 before rising to 24% in Q4 2021. From Q1 2022 to August 2022, 40% were due to infections, exposures or system precautions.

The median rescheduling delay pre-pandemic was 21 days compared to 63 days since March 2020. Kruskal-Wallis rank sum test showed subspecialties differences (p=0.02), with shortest delay in laryngology and longest in sleep surgery (median 33 days (IQR=27-90) vs 65 (45-87)). Since March 2020, 33% of cancelled cases were never rescheduled, of which 14% were head and neck oncologic surgeries.

Conclusions: While cancellations decreased to pre-pandemic levels by Q3 2021, they increased in Q4 2021 and Q1 2022 during the Delta and Omicron surges. Since March 2020, rescheduling delays for cancelled cases are three-fold longer than before the pandemic.

As new variants emerge, Covid-19 infections will continue to drive cancellations in the setting of current protocols. New strategies to reduce cancellations, encourage timely rescheduling and enhance operational resiliency in anticipation of future waves should be considered.