New national study led by UCLH clinician researchers reveals scale of cancelled and postponed operations across NHS hospitals in England

A major new study has shed light on how often planned operations are either postponed or cancelled across NHS hospitals in England and what can be done to reduce this.

The research, published in the British Journal of Anaesthesia, was carried out over seven days in November 2024, with 91 NHS Trusts taking part. It was led by UCLH’s National Institute of Health Research (NIHR) Central London Patient Safety Research Collaboration (CL-PSRC), NHS England and the Royal College of Anaesthetists.

The study found that one in ten operations was cancelled within 24 hours of the planned surgery date. Of these last-minute cancellations, nearly 40% were considered potentially avoidable. Around a quarter were caused by ‘acute’ (new, short-lived) medical problems such as coughs and colds which meant that surgery should be delayed; however, had these been identified earlier, other patients could have been brought forward to have their surgery instead.

In addition, 9% of people attending for their pre-operative assessment appointment were told that their operation would need to be postponed. In most cases, this was because patients had not been fully prepared or were not in the best health for surgery. More than six in ten postponements happened because patients needed further tests or a specialist review often relating to other health conditions they were already living with.

The study also found that a quarter of operating lists were running inefficiently, due to scheduling problems, staffing issues or delays in patients arriving.

This research matters because more than six million people in England are currently waiting for planned surgery. For many, that wait is already many months long. A last-minute cancellation or postponement not only causes anxiety and distress it can also lead to worsening health and poorer outcomes.

The study's lead author was UCLH consultant anaesthetist and CL-PSRC postdoctoral fellow Dr James Bedford. He 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. 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,” he said.

UCLH resident doctor and study co-author Dr Adam Hunt said: “Nearly half of all postponements involved patients needing further tests or specialist review. These could have been identified and addressed much earlier in the pathway, before patients reached pre-operative assessment.”

The study’s corresponding author is Professor Ramani Moonesinghe, who is director of the CL-PSRC and lead for the critical and perioperative care theme lead at the National Institute of Health Research UCLH Biomedical Research Centre. She said that the findings point towards an opportunity for better implementation of perioperative care pathways.

“NHS England has recommended screening patients all patients on waiting lists, as early as possible, for health conditions which could increase the risk of a delayed or incomplete recovery after surgery. Better implementation of this approach would use the time while patients wait for surgery to improve their overall health, and reduce the risk of late postponement, last minute cancellation, and problems after surgery.”