One in ten NHS operations cancelled at short notice, with patients’ own health a leading cause
One in ten planned NHS operations are cancelled within 24 hours of surgery, and a significant proportion of those cancellations are down to patients not being adequately prepared, according to a major new study.
The research, published in the British Journal of Anaesthesia, is the first national overview of its kind. Led by University College London Hospitals (UCLH) and carried out over seven days in November 2024, it covered 91 NHS Trusts and nearly 20,000 planned procedures.
Separately, 9% of patients attending a preoperative assessment clinic, an appointment typically held weeks before surgery to evaluate fitness to proceed, were also turned away without being cleared for their operation.
The majority of those postponements were because patients had not been adequately prepared. Over 60% were sent away because they needed further tests or specialist review, often as a result of underlying medical conditions that had not been managed in advance.
Of the last-minute cancellations, 37% were considered potentially avoidable by clinicians. Around a quarter of all cancellations were caused by acute medical problems, such as coughs and colds, which made it unsafe to proceed. Had these been picked up three to five days earlier, researchers say, the slot could either have been saved or offered to another patient.
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Lead author Dr James Bedford, a consultant anaesthetist at UCLH, said the findings highlight the need for earlier and more thorough checks before patients reach the operating table.
“Identifying health problems at the point a patient joins the waiting list rather than shortly before surgery gives time to treat those issues and get patients in the best possible shape for their operation,” he said.
“It also makes it easier to identify patients who are fit and ready to be called in at short notice, reducing waiting times and making better use of theatre time.”
Co-author Dr Adam Hunt added: “Too many patients are not in the best health at surgery, causing avoidable cancellations. We need earlier interventions while patients wait to improve outcomes and resource use.”
The study also found that a quarter of all operating lists were running inefficiently, with scheduling, staffing and organisational issues among the causes.
The findings come as more than six million patients remain on waiting lists for elective care in England. Progress on reducing those numbers has stalled, according to the Public Accounts Committee, despite billions being spent on new surgical hubs and additional lists.
Dr Claire Shannon, President of the Royal College of Anaesthetists, said the research showed why strengthening perioperative care must be a priority. “Delivering joined-up, patient-centred care before, during and after surgery leads to better outcomes for patients and is more efficient and cost-effective for the NHS.”
Dr Denny Levett, Director of the Centre for Perioperative Care, said that “so many last-minute cancellations in elective surgery could be avoided by earlier screening and better preparation before surgery,” adding that without a different approach, waiting lists would “remain unacceptably high”.
The study was a collaboration between UCL, the NIHR Central London Patient Safety Research Collaboration, NHS England and the Royal College of Anaesthetists.
The full study, The Postponement and Cancellations in Elective Care study: a national evaluation of case postponements and cancellations in elective surgical pathways, is published in the British Journal of Anaesthesia.
