Elective surgical cancellations in four South African referral hospitals: a retrospective theatre logbook audit protocol

Kedibone Maake; Wezile Wilson Chitha; Sibusiso Cyprian Nomatshila; Sikhumbuzo Advisor Mabunda

doi:10.12688/f1000research.184645.1

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Study Protocol

Elective surgical cancellations in four South African referral hospitals: a retrospective theatre logbook audit protocol

[version 1; peer review: awaiting peer review]

Kedibone Maake ^1-3, Wezile Wilson Chitha^1,2, Sibusiso Cyprian Nomatshila^1,4, Sikhumbuzo Advisor Mabunda^1,3,5

PUBLISHED 11 Jul 2026

Author details Author details

¹ School of Public Health, Walter Sisulu University, Mthatha, Eastern Cape, 5117, South Africa
² Institute for Clinical Governance and Healthcare Administration, Walter Sisulu University, East London, Eastern Cape, 5201, South Africa
³ Global Centre for Human Resources for Health Intelligence, Walter Sisulu University, Mthatha, Eastern Cape, 5117, South Africa
⁴ Society and Health Research Institute, Walter Sisulu University, Mthatha, Eastern Cape, 5117, South Africa
⁵ School of Population Health, University of New South Wales, Sydney, New South Wales, Australia

Kedibone Maake
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing

Wezile Wilson Chitha
Roles: Conceptualization, Funding Acquisition, Resources, Validation, Writing – Review & Editing

Sibusiso Cyprian Nomatshila
Roles: Project Administration, Resources, Visualization, Writing – Review & Editing

Sikhumbuzo Advisor Mabunda
Roles: Conceptualization, Investigation, Methodology, Software, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS AWAITING PEER REVIEW

This article is included in the Public Health and Environmental Health collection.

Abstract

Cancellation of elective surgical procedures undermines operating theatre efficiency, prolongs patient suffering, and increases healthcare costs. In low- and middle-income countries, including South Africa, such inefficiencies further intensify existing surgical backlogs, disproportionately impacting public facilities where systemic challenges such as limited operating theatre capacity, staffing shortages, and logistical delays are prevalent. Despite global evidence on the causes of surgical cancellations, context-specific data from South Africa’s under-resourced regions remain scarce. This study protocol outlines a hospital-based audit designed to quantify the prevalence, determinants, and avoidable factors associated with elective surgical cancellations in public hospitals across South Africa’s Eastern Cape and Mpumalanga provinces. A retrospective, quantitative, cross-sectional audit of theatre logbooks will be conducted at four public referral hospitals, covering all elective surgical slates from 1 April 2023 to 31 March 2024. Daily records of scheduled, performed, and cancelled elective cases will be extracted to determine the overall and hospital-specific cancellation rates, categorise documented reasons for cancellation, classify cancellations as avoidable or unavoidable, and calculate the proportion of slates commencing on time, at or before 08:00. Quantitative data analysis will involve entering survey data into Microsoft Excel 2021 for Windows, followed by exporting it to STATA version 18.5 for more detailed examination. Descriptive statistics, frequencies, percentages, and graphical summaries will characterise cancellation patterns across hospitals, surgical disciplines, and time periods. Ethical clearance has been granted by the Human Research Ethics Committee of the Faculty of Medicine and Health Sciences at Walter Sisulu University, Ref: WSU HREC 051/2025. Approval to access the research sites has been obtained from both the Provincial Health Research Committees of the Eastern Cape (Ref: EC_202505_029) and Mpumalanga (Ref: MP_202506_003). Findings will be disseminated through peer-reviewed publications, conference presentations, and feedback to participating hospitals and provincial health departments to inform theatre efficiency interventions.

Keywords

Elective surgical cancellations, theatre efficiency, preoperative delays, public hospitals, South Africa

Corresponding author: Kedibone Maake

Competing interests: No competing interests were disclosed.

Grant information: South African Medical Research Council–Research Capacity Development Division–Grant Number 57006
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Copyright: © 2026 Maake K et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Maake K, Chitha WW, Nomatshila SC and Mabunda SA. Elective surgical cancellations in four South African referral hospitals: a retrospective theatre logbook audit protocol [version 1; peer review: awaiting peer review]. F1000Research 2026, 15:1134 (https://doi.org/10.12688/f1000research.184645.1) First published: 11 Jul 2026, 15:1134 (https://doi.org/10.12688/f1000research.184645.1) Latest published: 11 Jul 2026, 15:1134 (https://doi.org/10.12688/f1000research.184645.1)

Introduction

Globally, studies indicate that the cancellation rates for elective surgical cases can range from 10% to over 30%, depending on the specific institutional context and the efficiency of the healthcare system.¹^–⁴ Elective surgeries are any surgical procedures scheduled in advance and not involving medical emergencies.² Elective surgical case cancellation refers to the cancellation of scheduled surgeries after the patient has been notified of the operation date, either on the day of or the day before surgery.⁵ The current literature identifies various factors contributing to case cancellations, including patient-related issues such as missed appointments, insufficient preparation, or changes in medical condition, as well as systemic challenges such as time constraints in the operating room, staffing shortages, and equipment failures.¹^–⁴ Cancelling cases disrupts the flow of medical services and can lead to worsening health outcomes for patients, increased risk of complications, and even mortality, highlighting the urgent need to address this issue.²^,⁴

In resource-constrained health systems, particularly in low- and middle-income countries (LMICs), surgical cancellations are exacerbated by systemic challenges, including workforce shortages, infrastructural inadequacies, and organisational inefficiencies.⁶^,⁷ In LMICs, cancellation rates can reach 48.5%, while in high-income countries (HICs), rates as low as 3.6% have been reported.¹^,⁸ South Africa, a middle-income country facing considerable healthcare disparities, is not exempt from these challenges.²^,⁹ Although existing literature is limited, it highlights alarmingly high cancellation rates in public hospitals.²^,¹⁰^,¹¹ The reasons behind these cancellations often include insufficient staffing, the unavailability of necessary equipment, and patient-related issues such as non-attendance or being deemed unfit for surgery on the day of the procedure.²^–¹⁰

Studies from various South African public hospitals highlight pervasive issues, including delayed theatre start times, underutilisation of surgical schedules, and high rates of elective surgery cancellations.²^,¹⁰^,¹¹ For instance, a prospective audit conducted at a Durban regional hospital revealed that only 36.9% of available theatre time was utilised for actual surgeries, with 9.3% lost due to delayed first-case starts and 26.2% of elective cases cancelled on the day of surgery, nearly half of which were categorised as avoidable.¹⁰ A similar evaluation of paediatric surgical theatre utilisation at the Chris Hani Baragwanath Academic Hospital reported utilisation below the global benchmark of 80%, primarily due to inefficiencies, including delayed patient transfers and prolonged induction times.¹² Efficient surgical services are a cornerstone of a well-functioning healthcare system, ensuring timely access to necessary interventions and optimising patient outcomes. The consequences of cancellations extend beyond operational inefficiencies. Patients face prolonged pain, disease progression, and socioeconomic hardships from repeated preoperative preparations.¹³^,¹⁴ Furthermore, healthcare workers, already operating under stress, experience demoralisation and burnout due to recurrent workflow disruptions.¹³^,¹⁴ At a systemic level, these cancellations exacerbate backlogs, increase costs, and undermine South Africa’s efforts to achieve Universal Health Coverage under the National Health Insurance framework.¹⁰^,¹⁵^,¹⁶

Public hospitals, particularly in rural and resource-limited provinces such as the Eastern Cape and Mpumalanga, face unique challenges that intensify the burden of surgical cancellations.⁹^,¹⁷^,¹⁸ In South Africa’s Eastern Cape, a predominantly rural area experiencing significant staff shortages and resource deficits, elective cancellation rates at regional facilities have been reported to be as high as 14.4%.² This study aims to systematically document these challenges and provide evidence-based insights to inform targeted interventions that enhance efficiency and reduce cancellations, ultimately improving the delivery of surgical care in resource-constrained settings. Furthermore, the study seeks to identify both shared and context-specific barriers by comparing operational performance across two provinces with distinct demographic and systemic characteristics. By collecting rigorous empirical data, the study aims to inform evidence-based policies and operational strategies that will enhance theatre efficiency, minimise cancellations, and improve surgical access within South Africa’s public sector.

Protocol

Study design

The aim of this study protocol is to conduct an audit of elective surgical operations in selected public hospitals in the Eastern Cape and Mpumalanga provinces of South Africa. A retrospective, descriptive cross-sectional study will be conducted utilising the theatre registry to evaluate the proportion of elective surgical slates that commenced timeously at or before 08:00 from 01 April 2023 to 31 March 2024. This study will retrospectively collect and analyse daily records of elective surgical slates, cases, and cancelled elective operations to determine the cancellation rate and the reasons for cancellations in operating theatres. Cancellations will be categorised based on different specialities or reasons for cancellation, as well as the specific nature of each case. For the purposes of this study, a cancellation is defined as a case that is logged and scheduled in the operating theatre logbook prior to 14H00 on the preceding day but is not carried out on the designated day for any reason indicated.

Study setting

The study will be conducted in two rural provinces of South Africa, namely the Eastern Cape and Mpumalanga, both characterised by high poverty, unemployment, and socioeconomic inequality, which directly affect healthcare outcomes.¹⁷^,¹⁸ Despite numerous interventions, strategies, and investments by the Department of Health (DoH) to strengthen the healthcare system’s capacity to deliver quality services, both provinces continue to experience poor health outcomes.¹⁷^,¹⁸ In the Eastern Cape province, elective cancellation rates at regional facilities have been reported to be as high as 14.4%.² The research will focus on four hospitals: Nelson Mandela Academic Hospital and St Elizabeth Hospital in the Eastern Cape, Rob Ferreira Hospital and Themba Hospital in Mpumalanga. These hospitals serve as referral centres within their provinces, each providing various levels of specialised healthcare services. The selection of hospitals for the study used a simple random sampling technique to ensure an unbiased, representative sample.

Population and sampling

A convenience non-probability sampling method will be utilised to collect data from available theatre records in the four study hospitals.¹⁹ The study will encompass all records of patients scheduled for elective surgery across the four selected hospitals for the period between 01 April 2023 to 31 March 2024. A document audit review of all cancelled elective surgery cases and the commencement of elective surgical cases will be conducted, as documented in the operating theatre logbook. The sample size will be determined using Cochran’s formula based on the number of elective surgeries performed during this timeframe. A total combined sample size for all four hospitals will be calculated using the equation, $n = \frac{p (100 - p) z^{2}}{d^{2}}$ . For a one-sided 95% confidence interval and a 5% significance level (z = 1.96). Because the proportion (p) of cancelled elective surgeries is not known, this (p) will be set at 50%, and the desired precision (d) will be set at 3%. This thus yields a total minimum sample size of 1067. To account for data entry errors, an additional 20% (213) will be added, yielding a desired sample size of 1280 records across all four sites. Assuming an equal distribution of the total sample size among the four hospitals.

Data collection

An audit checklist will be utilised to extract unaltered data from theatre records. The data collection tool was adapted from previous studies on a similar topic.²^,⁶^,²⁰ The data to be reviewed will include the dependent variable, case cancellation; independent variables will include the patient’s demographics, the time of first and last procedure (the completion time of the elective procedure on any given day) on the elective slate, planned procedure, and reasons for cancellation, such as patient-related, medical-related, management-related, shortage of time, staff-related, and incomplete investigation. They will be further stratified into avoidable or unavoidable. Data will be collected by researchers with clinical backgrounds after they have received adequate training.

Validity and reliability of the study

To ensure the study’s validity, researchers carefully designed an audit checklist that measured only what it intended to measure. To further strengthen the reliability of the data collection instrument, tools used in previous research were adapted to align with the study’s specific research questions and objectives. Furthermore, the involvement of trained researchers in the data collection process will bolster the reliability of the information obtained.

A pilot study will be conducted to assess the data collection tool’s effectiveness in measuring the intended concepts.²¹ Ten theatre records will be extracted from a referral hospital in the Eastern Cape province, similar to the study hospital, for pre-testing of the audit checklist. This pre-testing of the audit checklist aims to identify potential problem areas, minimise measurement error, and ensure accurate interpretation. The audit checklist will be finalised only after pre-testing is completed.

The reliability of the checklist will be evaluated using STATA version 18.5, through the calculation of Cronbach’s alpha (α), which is the most widely utilised measure of reliability.²² This coefficient assesses the internal consistency or reliability of a set of survey items, helping to ascertain whether the items collectively measure the same characteristic.²² Cronbach’s alpha provides a quantifiable measure of agreement on a standardised scale ranging from 0 to 1, with higher values indicating greater agreement among items.²²

Data management and analysis

Quantitative data analysis will entail entering survey data into Microsoft Excel 2021 for Windows and subsequently exporting it to Stata 18.5 for further analysis. Descriptive and categorical data will be analysed through frequencies, percentages, and graphical representations. The normality of numerical data will be evaluated using the Shapiro-Wilk test. If the data is normally distributed, the results will report the mean, range, and standard deviation. In cases of non-normality, the median and interquartile range (IQR) will be used. Statistical comparisons will utilise the Chi-squared test or Fisher’s exact test, depending on the expected frequencies. The One-Way Analysis of Variance (ANOVA) or the Kruskal-Wallis test will be used to compare the mean or median ages of elective surgical cases or participants, depending on the normality of the distribution. A significance level of p-value ≤0.05 will be established, and a 95% confidence interval will be applied to ensure the precision of estimates.

Primary and secondary outcomes

The primary outcome of this study is the overall percentage of elective surgical cases that are cancelled on the day of surgery during the study period. A case will be considered cancelled if it was scheduled for an elective surgery list and recorded in the theatre logbook but did not proceed as originally planned on the designated day. Cancellation status will be determined through a retrospective review of operating theatre logbooks from 01 April 2023 to 31 March 2024. Data will be collected using a standardised audit tool designed to capture scheduled cases, cancellations, and the documented reasons for each cancellation. Each scheduled surgical case will be treated as a single unit of analysis, regardless of whether the patient is rescheduled later.

For secondary outcomes, the focus will be on categorising and quantifying the reasons for elective surgical case cancellations, which will be mapped to predefined indicator domains. For each domain, the outcome will be expressed as the proportion of total cancellations attributed to that category. These outcomes will be measured as follows: Patient-related factors may include situations in which a patient is deemed unfit for surgery due to comorbidities or failure to adhere to preoperative instructions. This information will be extracted from theatre logbook entries and supported by available preoperative assessment records. Medical-related factors, such as unstable vital signs, will be documented from theatre logs and perioperative notes. Management-related factors, such as double-booked procedures, will be identified from scheduling records and theatre lists. Staff-related factors, such as insufficient personnel for the procedure, will be derived from staff rosters, surgical schedules, and theatre documentation. Finally, facility-related factors, including equipment failures or unavailability, will be confirmed from theatre log entries and hospital incident reports, when available.

Dissemination

Research findings will be shared utilising various methods, including workshops, media releases, seminars, conferences, and publications in peer-reviewed journals. This strategy will ensure that the findings effectively reach the relevant stakeholders and can inform decisions, policies, and future research initiatives.

Study status

Data collection at the four study sites will take place concurrently from 01 August to 31 August 2026. Data analysis and interpretation are scheduled to begin on 01 September and conclude on 30 September 2026. As of this submission, none of the study phases, including data collection or analysis, have been initiated.

Discussion

Elective surgical case cancellations and delayed starts pose significant challenges for healthcare systems worldwide, resulting in substantial financial losses, resource waste, and detrimental impacts on patient care and satisfaction. This study protocol outlines a rigorous approach to auditing inefficiencies in elective surgery in South Africa’s Eastern Cape and Mpumalanga Provinces, with a specific focus on delays and cancellations. The findings aim to guide operational improvements, such as enhanced preoperative protocols and better resource prioritisation, in a context where public hospitals face high surgical demand amid limited capacity. However, several practical and operational issues must be addressed when conducting this cross-sectional audit. Collecting uniform data across multiple hospitals, each with potentially different documentation practices, presents significant logistical challenges. Researchers will consider inconsistencies in record-keeping across facilities, which can result in missing or incomplete data. To maintain uniformity, standardised data-collection tools and regular training sessions for data collectors across all sites will be utilised.

Documenting the reasons for cancellations and delays may reveal sensitive operational deficiencies within specific institutions. Therefore, researchers will navigate these issues diplomatically to secure institutional cooperation while ensuring accurate data collection. Presenting the findings in a manner that emphasises systemic improvements rather than placing blame will be crucial. The study will consider the unique contexts of each institution, including varying levels of resource availability, staffing models, and patient demographics across different hospitals. These factors can significantly influence cancellation and delay rates, but quantifying and standardising them in analysis may be challenging. Focusing on select hospitals within two provinces might limit the generalisability of the findings across South Africa’s diverse healthcare landscape. The nine provinces of the country exhibit substantial variations in health system capacity, disease burden, and socioeconomic conditions. For example, urban academic centres in Gauteng and the Western Cape provinces face markedly different challenges than rural hospitals in Limpopo or the Northern Cape.

While the findings from the Eastern Cape and Mpumalanga may not be directly applicable to other contexts without accounting for local factors, the protocol provides a solid framework for generating actionable data to inform healthcare policy and operational improvements. In addition, the study makes a significant contribution to understanding surgical efficiency in resource-constrained settings and is relevant to healthcare systems in LMICs. Future research could expand on these findings by incorporating mixed-methods approaches to explore the qualitative aspects of reasons for cancellation and by implementing intervention studies to test strategies to improve theatre efficiency. By recognising and addressing these operational issues, researchers can enhance the credibility and usefulness of their findings, ultimately contributing to improved surgical service delivery in South Africa’s public health system. Furthermore, the study will contribute significantly to national discussions on strengthening health systems and provide actionable insights for hospital administrators, policymakers, and healthcare teams focused on reducing cancellations and enhancing the delivery of surgical care.

Ethical considerations

The present protocol describes a sub-study conducted as part of a broader ethically approved research project entitled “Exploring clinical governance and organisational learning in public sector hospitals in the Eastern Cape and Mpumalanga provinces of South Africa.” Ethical clearance was granted by the Human Research Ethics Committee of the Faculty of Medicine and Health Sciences at Walter Sisulu University (Ref: WSU HREC 051/2025). Approval to access the research sites has been obtained from both the Provincial Health Research Committees of the Eastern Cape (Ref: EC_202505_029) and Mpumalanga (Ref: MP_202506_003) departments. This protocol shares the same ethical clearance reference as a previously approved related protocol, as both protocols are distinct sub-studies within the same overarching project.²³ Prior to data collection, entry to the study sites will be further negotiated with the hospital chief executive officers. Consent to participate is not applicable, as this study involves the retrospective review of routinely recorded operating theatre logbook data, with no direct contact with patients and no collection of individually identifiable participant information.

Acknowledgements

The work reported herein was made possible through funding by the South African Medical Research Council through its Division of Research Capacity Development under the SAMRC Researcher Development Award from funding received from the South African National Treasury. The content hereof is the sole responsibility of the authors and does not necessarily represent the official views of the SAMRC or the funders.

Data availability

Underlying data

No data is associated with this article.

References

1. Abate SM, Chekole YA, Minaye SY, et al.: Global prevalence and reasons for case cancellation on the intended day of surgery: a systematic review and meta-analysis. International Journal of Surgery Open. 2020 Jan 1; 26: 55–63. Publisher Full Text
2. Sukwana A, Mrara B, Oladimeji O: Prevalence and causes of elective surgical cancellations: findings from a rural tertiary hospital in the Eastern Cape, South Africa. Healthcare. MDPI; 2023 Jan 15; Vol. 11(2): p. 270. Publisher Full Text
3. Wong DJ, Harris SK, Moonesinghe SR, et al.: Cancelled operations: a 7-day cohort study of planned adult inpatient surgery in 245 UK National Health Service hospitals. Br. J. Anaesth. 2018 Oct 1; 121(4): 730–738. PubMed Abstract | Publisher Full Text
4. Koushan M, Wood LC, Greatbanks R: Evaluating factors associated with the cancellation and delay of elective surgical procedures: a systematic review. Int. J. Qual. Health Care. 2021 Jun 1; 33(2): mzab092. Publisher Full Text
5. Al Talalwah N, McIltrot KH: Cancellation of surgeries: integrative review. Journal of Peri Anaesthesia Nursing. 2019 Feb 1; 34(1): 86–96. Publisher Full Text
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Version 1

VERSION 1 PUBLISHED 11 Jul 2026

Author details Author details

¹ School of Public Health, Walter Sisulu University, Mthatha, Eastern Cape, 5117, South Africa
² Institute for Clinical Governance and Healthcare Administration, Walter Sisulu University, East London, Eastern Cape, 5201, South Africa
³ Global Centre for Human Resources for Health Intelligence, Walter Sisulu University, Mthatha, Eastern Cape, 5117, South Africa
⁴ Society and Health Research Institute, Walter Sisulu University, Mthatha, Eastern Cape, 5117, South Africa
⁵ School of Population Health, University of New South Wales, Sydney, New South Wales, Australia

Kedibone Maake
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing

Wezile Wilson Chitha
Roles: Conceptualization, Funding Acquisition, Resources, Validation, Writing – Review & Editing

Sibusiso Cyprian Nomatshila
Roles: Project Administration, Resources, Visualization, Writing – Review & Editing

Sikhumbuzo Advisor Mabunda
Roles: Conceptualization, Investigation, Methodology, Software, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

South African Medical Research Council–Research Capacity Development Division–Grant Number 57006
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Published: 11 Jul 2026, 15:1134

https://doi.org/10.12688/f1000research.184645.1

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© 2026 Maake K et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Maake K, Chitha WW, Nomatshila SC and Mabunda SA. Elective surgical cancellations in four South African referral hospitals: a retrospective theatre logbook audit protocol [version 1; peer review: awaiting peer review]. F1000Research 2026, 15:1134 (https://doi.org/10.12688/f1000research.184645.1)

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[1] 1. Abate SM, Chekole YA, Minaye SY, et al.: Global prevalence and reasons for case cancellation on the intended day of surgery: a systematic review and meta-analysis. International Journal of Surgery Open. 2020 Jan 1; 26: 55–63. Publisher Full Text

[2] 2. Sukwana A, Mrara B, Oladimeji O: Prevalence and causes of elective surgical cancellations: findings from a rural tertiary hospital in the Eastern Cape, South Africa. Healthcare. MDPI; 2023 Jan 15; Vol. 11(2): p. 270. Publisher Full Text

[3] 3. Wong DJ, Harris SK, Moonesinghe SR, et al.: Cancelled operations: a 7-day cohort study of planned adult inpatient surgery in 245 UK National Health Service hospitals. Br. J. Anaesth. 2018 Oct 1; 121(4): 730–738. PubMed Abstract | Publisher Full Text

[4] 4. Koushan M, Wood LC, Greatbanks R: Evaluating factors associated with the cancellation and delay of elective surgical procedures: a systematic review. Int. J. Qual. Health Care. 2021 Jun 1; 33(2): mzab092. Publisher Full Text

[5] 5. Al Talalwah N, McIltrot KH: Cancellation of surgeries: integrative review. Journal of Peri Anaesthesia Nursing. 2019 Feb 1; 34(1): 86–96. Publisher Full Text

[6] 6. Al Khawalde M, Al Gudah F, Al Soud N, et al.: Cancellation of elective surgical procedures: a single royal medical services hospital experience. Journal of the Royal Medical Services. 2015 Dec; 102(2053): 1–5. Publisher Full Text

[7] 7. Koh WX, Phelan R, Hopman WM, et al.: Cancellation of elective surgery: rates, reasons, and effect on patient satisfaction. Can. J. Surg. 2021 Apr; 64(2): E155–E161. PubMed Abstract | Publisher Full Text | Free Full Text

[8] 8. Da’ar OB, Al-Mutairi T: How do patient demographics, time-related variables, reasons for cancellation, and clinical procedures affect frequency of same-day operating room surgery cancelation? A maximum likelihood method. BMC Health Serv. Res. 2018 Jun 15; 18(1): 454.

[9] 9. Maphumulo WT, Bhengu BR: Challenges of quality improvement in the healthcare of South Africa post-apartheid: A critical review. Curationis. 2019 Jan 1; 42(1): 1–9.

[10] 10. Asmal II, Cronjé L, Keerath K: An audit of operating theatre utilisation and day-of-surgery cancellations at a regional hospital in the Durban metropole. S. Afr. Med. J. 2019 Oct 1; 109(10): 765–770. Nair S, Cotwall F, Basu D, Tshabalala K. An Audit of Theatre Operating Efficiency at a Central Hospital in South Africa. Perioperative Care and Operating Room Management. 2025 Jun 10:100506.

[11] 11. Ehlers VU, Kohler CF, Tefera A, et al.: The burden of emergency abdominal surgery heavily outweighs elective procedures in KwaZulu-Natal Province, South Africa. J. Surg. Res. 2021 Mar 1; (259): 414–419. Publisher Full Text

[12] 12. Ford S, Brink N, Martin N, et al.: Utilisation of paediatric surgical theatres at the Chris Hani Baragwanath Academic Hospital, Johannesburg. South African Journal of Child Health. 2021 Dec 1; 15(4): 185–188. Publisher Full Text

[13] 13. Drake-Brockman TF, Chambers NA, Sommerfield D, et al.: The impact of surgical cancellations on children, families, and the health system in an Australian paediatric tertiary referral hospital. Pediatr. Anesth. 2021 May; 31(5): 578–586. PubMed Abstract | Publisher Full Text

[14] 14. Armoeyan M, Aarabi A, Akbari L: The effects of surgery cancellation on patients, families, and staff: a prospective cross-sectional study. J. Perianesth. Nurs. 2021 Dec 1; 36(6): 695–701. PubMed Abstract | Publisher Full Text

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Elective surgical cancellations in four South African referral hospitals: a retrospective theatre logbook audit protocol

Abstract

Keywords

Introduction

Protocol

Study design

Study setting

Population and sampling

Data collection

Validity and reliability of the study

Data management and analysis

Primary and secondary outcomes

Dissemination

Study status

Discussion

Ethical considerations

Acknowledgements

Data availability

Underlying data

References

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