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Trends of Ocular Surgery Cancellations Before and After the COVID-19 Pandemic at a County Hospital
Gina Yu, MD
Gina Yu . Michael Yu . Suzanne Michalak . Kapil Mishra . Carolyn Pan 
1. Byers Eye Institute, School of Medicine, Stanford University, Palo Alto, CA, USA.
2. Wilmer Eye Institute, Department of Ophthalmology, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
To determine primary reasons for ocular surgery cancellations by subspecialty at a tertiary county hospital and how cancellation rates altered following the COVID-19 pandemic. Surgical cancellations lead to delays in patient care which can detrimentally affect ophthalmic health. Understanding trends in cancellation can identify predictive and preventative factors for future cancellations.
This retrospective study included a consecutive sample of patients who had an ophthalmic surgery scheduled at the Santa Clara Valley Medical Center, San Jose, CA between 2012 and 2021. An automated search pulled 11,369 surgeries scheduled (8527 completed and 2842 cancelled, 1086 with reasons identified). Statistical analysis was completed with STATA (version 17 MP2).
A total of 11,369 surgeries were analyzed, including surgeries for cataract, pterygium and ocular surface, glaucoma, pediatrics, plastics, and retina, with no statistically significant differences in demographics by subspecialty, except for mean age with pediatric surgeries (p=0.98). The most frequently cancelled subspecialty was pediatrics (36.4%), followed by plastics (35.9%), cataract (28.5%), glaucoma (21.1%), retina (19.3%), and pterygium and ocular surface (17.0%). However, during the COVID-19 pandemic, plastics surgeries were most frequently cancelled. For the 1086 surgeries with reasons for cancellation identified, surgeon decision was the most common reason, followed by patient decision, and patient health. Surgeon reasons to cancel included limitations in resources available. Patient reasons to cancel included family emergencies, transportation, or refusal. In 2020, the most common reason for cancellation was COVID-19 related rescheduling, which differed from any of the other years analyzed. The overall cancellation rate was 24.9% and was lowest in 2021 and highest in 2020, the peak of the COVID-19 pandemic (15% compared to 38%, p<0.01).
The type of surgery influenced the rate of cancellation, with pediatric surgeries having the most frequent cancellations. The COVID-19 pandemic significantly increased the rate of cancellation at its peak and changed the most common reason for cancellation from other years analyzed. Future studies analyzing specific patient- and surgeon-driven reasons for cancellation may aid in strategies to help reduce cancellation rates.