Beyond the Cancellation: Identifying Avoidable and Non-avoidable Causes of Elective Operation Theatre Cancellations in a Tertiary Care Hospital

Background Elective operation theatre (OT) cancellations are an important indicator of perioperative quality and healthcare efficiency. Most studies describe the frequency and causes of cancellations without distinguishing between avoidable and non-avoidable events, limiting the identification of actionable targets for quality improvement. This study aimed to classify elective OT cancellations according to avoidability and identify the major modifiable causes. Methods This retrospective observational study was conducted at the All India Institute of Medical Sciences (AIIMS), Nagpur, Maharashtra, India. All elective surgical procedures cancelled after formal OT scheduling between December 2024 and June 2025 were included. Data were obtained from the OT cancellation registry, electronic medical records, anaesthesia records and patient case files. Cancellations were classified as avoidable, non-avoidable or unclassified using predefined criteria. Pareto analysis was performed to identify the principal modifiable causes of avoidable cancellations. Results Of 2,744 scheduled elective procedures, 247 were cancelled, resulting in an overall cancellation rate of 9.0%. Among the cancelled cases, 153 (61.9%) were classified as avoidable, 42 (17.0%) as non-avoidable, and 52 (21.1%) as unclassified because of insufficient documentation. Administrative and scheduling-related factors accounted for the largest proportion of cancellations (46.6%). Lack of OT time was the leading avoidable cause (59.5%), followed by inadequate preoperative preparation (9.2%), OT scheduling/admission-related issues (7.2%), and unavailability of intensive care unit beds (5.2%). Pareto analysis showed that these four factors accounted for over 80% of avoidable cancellations. Conclusion Most elective OT cancellations were attributable to potentially preventable system-related factors. Targeted interventions focusing on OT scheduling, preoperative assessment, multidisciplinary communication and resource planning may reduce avoidable cancellations, improve OT utilization and enhance perioperative care.