Nearly two in five operations cancelled at the last minute in England could be avoided, according to a major analysis that has prompted experts to demand an urgent overhaul of how the NHS prepares patients for surgery.
The study, published in the British Journal of Anaesthesia, examined data from 91 NHS trusts over a single week in November 2024. During that period, 22,573 preoperative assessment appointments and 19,905 planned procedures were logged across 78 trusts, with 2,190 postponements recorded overall. The national rate of planned surgeries cancelled within 24 hours stood at 10 per cent – roughly one in ten. Researchers calculated that 37.3 per cent of those cancellations were “potentially avoidable”.
The top three reasons for last-minute cancellations were acute medical conditions, operating list overruns, and patients failing to attend. But the analysis also found that 9 per cent of preoperative assessment appointments resulted in postponements, most of which were linked to patients not being adequately prepared. In 61 per cent of those cases, the delay was caused by the need for further tests, a specialist anaesthetic review or a medical review – often because of other underlying health conditions.
Dr James Bedford, of University College London, the lead author of the study, said the findings underlined “the need for better implementation of patient care ahead of surgery, across the NHS”. Working alongside the National Institute of Health Research Central London Patient Safety Research Collaboration, NHS England and the Royal College of Anaesthetists, Dr Bedford’s team highlighted a critical window of opportunity: if problems were identified three to five days earlier, the cancellation could either have been prevented or another patient could have been booked into the operating slot. He added: “In particular – and in keeping with standards issued by NHS England – we need to ensure we identify health problems, which put patients at risk of postoperative complications, as early as possible, so that these can be improved while they are waiting for their operation. The process of early screening also helps to identify patients who are low risk, who can potentially be called to have surgery at short notice, therefore reducing their waiting time, and improving service efficiency.”
Perioperative care: the key to reducing cancellations
The study has sharpened the focus on perioperative care – the co-ordinated management of patients before, during and after an operation. Dr Claire Shannon, president of the Royal College of Anaesthetists, said: “This study shows why strengthening perioperative care must be a priority. Delivering joined-up, patient-centred care before, during and after surgery leads to better outcomes for patients and is more efficient and cost effective for the NHS.”
Professor Scarlett McNally, a consultant orthopaedic surgeon who wrote a linked editorial, described the findings as revealing “the scale of systemic inefficiencies, unacceptable waste of public money and emotional toll experienced by patients”. She warned that NHS England had spent billions building new surgical hubs, but that “such stand-alone units do not operate on patients at greater risk of complications, those who are older, or living with underlying health conditions and in need of the additional back-up of an NHS hospital. Without a different approach that focuses on supporting and preparing these patients, waiting lists will remain unacceptably high as procedures are too frequently postponed or cancelled.”
The call for better preparation is backed by guidance already issued by NHS England. Its Theatres, Surgery, and Perioperative Care: Clinical and Operational Improvement Guide, part of the NHS IMPACT programme, recommends early risk stratification and patient optimisation before surgery. This includes screening for risk factors such as diabetes, anaemia and obesity no later than when a patient is added to the waiting list. If such conditions are addressed in advance, experts say, the chance of a last-minute cancellation or complication drops significantly.
Dr Denny Levett, director of the Centre for Perioperative Care (CPOC) – a cross-organisational initiative established by the Royal College of Anaesthetists in 2019 – said: “So many last-minute cancellations in elective surgery could be avoided by earlier screening and better preparation before surgery.” CPOC promotes a patient-centred approach from the initial contemplation of surgery through to full recovery.
Surgical hubs are also being expanded as part of the strategy to tackle waiting lists and reduce cancellations. As of September 2024, 108 surgical hubs were operating across the country, with a further 26 planned to open by the end of 2025. These specialised units separate elective care from emergency admissions, thereby lowering the risk of short-notice cancellations caused by bed pressures or emergency cases.
Professor Frank Smith, vice-president of the Royal College of Surgeons of England, emphasised that “high-quality care before and after surgery is just as important as the operation itself”. He added: “Surgeons play a central role in leading teams to ensure patients are genuinely ready for surgery, not simply waiting for a date. The findings underline the need for earlier, better co-ordinated care so patients are in the best possible condition when they reach the operating theatre.”
The problem of cancellations comes against a backdrop of persistently high waiting lists. Figures published earlier this month showed the waiting time for hospital treatment in England fell for the fourth month in a row, with an estimated 7.22 million treatments waiting to be carried out at the end of February, relating to 6.11 million patients – down from 7.25 million treatments and 6.13 million patients at the end of January. Separate NHS data for February 2026 puts the waiting list at 7.29 million, the lowest since February 2023, and a record 18.4 million treatments and operations were carried out in 2025. Despite that progress, the 18-week treatment target has not been met since 2016.
Dr Shannon added: “Delivering joined-up, patient-centred care before, during and after surgery leads to better outcomes for patients and is more efficient and cost effective for the NHS.”