High Elective Surgery Cancellation Rate in Malawi Primarily Due to Infrastructural Limitations

Background: The provision of safe and timely surgical care is essential to global health care. Low- and middle-income countries have a disproportionate share of the global surgical disease burden and struggle to provide care with the given resources. Surgery cancellation worldwide occurs for many reasons, which are likely to differ between high-income and low-income settings. We sought to evaluate the proportion of elective surgery that is cancelled and the associated reasons for cancellation at a tertiary hospital in Malawi. Methods: This was a retrospective review of a database maintained by the Department of Anesthesiology at Kamuzu Central Hospital in Lilongwe, Malawi. Data were available from August 2011 to January 2015 and included weekday records for the number of scheduled surgeries, the number of cancelled surgeries, and the reasons for cancellation. Descriptive statistics were performed. Results: Of 10,730 scheduled surgeries, 4740 (44.2%) were cancelled. The most common reason for cancellation was infrastructural limitations (84.8%), including equipment shortages (50.9%) and time constraints (33.3%). Provider limitations accounted for 16.5% of cancellations, most often due to shortages of anaesthesia providers. Preoperative medical conditions contributed to 26.3% of cancellations. Conclusion: This study demonstrates a high case cancellation rate at a tertiary hospital in Malawi, attributable primarily to infrastructural limitations. These data provide evidence that investments in medical infrastructure and prevention of workforce brain drain are critical to surgical services in this region