1 in 10 NHS Surgeries Cancelled on the Day—37% Potentially Avoidable

One in ten NHS operations in England are cancelled on the day of surgery, with nearly 40% of these last-minute cancellations deemed potentially avoidable, according to a new national snapshot study. The findings, published in the British Journal of Anaesthesia, highlight systemic inefficiencies in preoperative preparation that contribute to patient distress, clinical setbacks and further strain on an already overburdened healthcare system.

Study Reveals Scale of Last-Minute Cancellations

The research, conducted over a seven-day period in November 2024, analysed data from 91 NHS trusts across England. It found that 10% of elective surgeries were cancelled within 24 hours of the scheduled procedure, while an additional 9% were postponed during preoperative assessment clinics—appointments designed to evaluate a patient’s fitness for surgery. If extrapolated nationally, these figures would equate to approximately 300,000 cancellations or postponements annually.

Clinicians identified 37.3% of last-minute cancellations as potentially avoidable. The most common reasons included patients being medically unprepared, failing to attend appointments, operating lists overrunning, and emergency admissions taking priority. However, researchers noted that many of these issues could have been addressed three to five days earlier, allowing alternative patients to fill the vacated slots and reducing wasted resources.

Patient and Systemic Consequences

The impact of last-minute cancellations extends beyond logistical disruptions. For patients, the abrupt postponement of surgery often leads to heightened anxiety, frustration, and in some cases, deteriorating health. Prolonged waits for procedures such as hip or knee replacements—already stretching into months—can exacerbate underlying conditions, resulting in poorer clinical outcomes.

Dr. Ramani Moonesinghe, lead author of the study and a professor at University College London (UCL), emphasised the broader implications: When surgery is cancelled at the last minute, it’s not just a missed appointment—it’s a missed opportunity to improve a patient’s quality of life. These delays can have cascading effects on their physical and mental well-being, as well as on the efficiency of the entire NHS.

The study also underscores the ongoing challenges faced by the NHS in clearing the backlog of elective care, which has been exacerbated by the COVID-19 pandemic. As of February 2026, over six million patients remained on waiting lists for treatment in England. Despite efforts to reduce waiting times, progress has stalled, with the Public Accounts Committee warning in late 2025 that too many patients were still enduring excessive delays for tests, and procedures.

Root Causes and Potential Solutions

The research highlights several key areas where improvements could reduce cancellations. The most frequent cause of postponements was inadequate patient preparation, which accounted for a significant portion of avoidable cases. This includes failures to follow preoperative instructions, such as fasting requirements or medication adjustments, as well as unresolved medical concerns that could have been addressed earlier in the process.

Other contributing factors included:

• Operating lists running over schedule, leaving insufficient time for subsequent procedures.
• Emergency admissions taking precedence over planned surgeries.
• Patients not attending their preoperative assessment appointments or the surgery itself.
• Administrative or logistical issues, such as unavailable operating theatres or staffing shortages.

The study’s authors argue that many of these issues could be mitigated with better coordination and earlier intervention. For example, identifying patients at risk of cancellation three to five days in advance would allow healthcare teams to either resolve the underlying problem or reallocate the surgery slot to another patient. This approach could significantly reduce the number of wasted operating theatre hours, which are a precious resource in the NHS.

Broader Context: The NHS Backlog Crisis

The findings arrive at a critical juncture for the NHS, which has been grappling with unprecedented demand and resource constraints. The pandemic not only disrupted routine care but also led to a surge in patients requiring treatment for conditions that went undiagnosed or untreated during lockdowns. While the NHS has made some progress in reducing the longest waits, the overall backlog remains stubbornly high.

Efforts to address the crisis have included increased funding, the expansion of diagnostic hubs, and the use of independent sector providers to deliver additional capacity. However, these measures have yet to fully alleviate the pressure on the system. The study’s authors note that reducing last-minute cancellations could be a relatively low-cost way to improve efficiency and free up capacity for other patients.

Calls for Systemic Reform

Healthcare leaders and patient advocacy groups have responded to the study with calls for systemic reforms. The Royal College of Anaesthetists, which collaborated on the research, has urged NHS trusts to adopt more robust preoperative pathways to ensure patients are fully prepared for surgery. This could involve clearer communication with patients about preoperative requirements, as well as better integration between primary care, hospitals, and community services.

Dr. Fiona Donald, President of the Royal College of Anaesthetists, stated: This study shines a light on a persistent problem that affects thousands of patients every year. By addressing the root causes of last-minute cancellations, we can not only improve patient experiences but also make better use of NHS resources. It’s a win-win for patients and the healthcare system.

Patient groups have echoed these sentiments, emphasising the emotional toll of cancellations. Rachel Power, Chief Executive of the Patients Association, described the findings as deeply concerning and called for greater transparency and support for patients facing delays. When surgery is cancelled at the last minute, it’s not just an inconvenience—it can feel like a betrayal of trust. Patients need clear information about why their procedure was postponed and what steps are being taken to reschedule it as quickly as possible.

What Comes Next?

The study’s authors have outlined several recommendations to reduce cancellations, including:

• Implementing earlier preoperative assessments to identify and address potential issues before the day of surgery.
• Enhancing communication between hospitals and patients to ensure they understand and follow preoperative instructions.
• Improving scheduling practices to reduce overrunning operating lists and better accommodate emergency cases.
• Developing contingency plans to reallocate surgery slots when cancellations occur, ensuring that operating theatre time is not wasted.

While these measures may require upfront investment in staff training and administrative processes, the long-term benefits could be substantial. Reducing cancellations would not only improve patient outcomes but also help the NHS make more efficient use of its limited resources, ultimately contributing to the broader goal of reducing waiting times.

As the NHS continues to navigate the challenges of post-pandemic recovery, the findings of this study serve as a reminder of the importance of addressing systemic inefficiencies. For the millions of patients awaiting treatment, every cancelled operation represents a setback—but with targeted reforms, many of these setbacks could be avoided.