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Validation of statistical methods to compare cancellation rates on the day of surgery
Journal article   Open access   Peer reviewed

Validation of statistical methods to compare cancellation rates on the day of surgery

Franklin Dexter, Eric Marcon, Richard H Epstein and Johannes Ledolter
Anesthesia and analgesia, Vol.101(2), pp.465-473
08/2005
DOI: 10.1213/01.ANE.0000154536.34258.A8
PMID: 16037163
url
https://doi.org/10.1213/01.ANE.0000154536.34258.A8View
Published (Version of record) Open Access

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Abstract

We investigated the validity of several statistical methods to monitor the cancellation of electively scheduled cases on the day of surgery: chi(2) test, Fisher's exact test, Rao and Scott test, Student's t-test, Clopper-Pearson confidence intervals, and Chen and Tipping modification of the Clopper-Pearson confidence intervals. Discrete-event computer simulation over many years was used to represent surgical suites with an unchanging cancellation rate. Because the true cancellation rate was fixed, the accuracy of the statistical methods could be determined. Cancellations caused by medical events, rare events, cases lasting longer than scheduled, and full postanesthesia or intensive care unit beds were modeled. We found that applying Student's two-sample t-test to the transformation of the numbers of cases and canceled cases from each of six 4-wk periods was valid for most conditions. We recommend that clinicians and managers use this method in their quality monitoring reports. The other methods gave inaccurate results. For example, using chi(2) or Fisher's exact test, hospitals may erroneously determine that cancellation rates have increased when they really are unchanged. Conversely, if inappropriate statistical methods are used, administrators may claim success at reducing cancellation rates when, in fact, the problem remains unresolved, affecting patients and clinicians. Operating room cancellation rates can be monitored statistically by considering the number of canceled and performed cases during each 4-week period, performing a transformation of each period's cancellation rate, and then applying Student's t-test. Methods such as the Fisher's exact test and {chi}2 test should be avoided for this application because they can give erroneous results.
 Algorithms Elective Surgical Procedures - statistics & numerical data Data Interpretation, Statistical Reproducibility of Results Computer Simulation Humans Operating Rooms Postoperative Care - statistics & numerical data Appointments and Schedules

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