Factors Contributing to Failed General Anesthesia Appointments in a Pediatric Dental Residency Program

Abstract

Providing comprehensive dental treatment under general anesthesia (GA) is resource intensive, and the cost of failed appointments is substantial. When a patient has complex treatment needs, dental care under GA protects a patients psyche and ensures the health and safety of both the patient and the dental team. The objective of this prospective cohort study was to investigate factors associated with attendance to GA appointments at an outpatient dental surgery center associated with the University of Washington Pediatric Dentistry Residency program. The study sample included all patients under age 21 who were scheduled for comprehensive dental care under GA at the UW Center for Pediatric Dentistry during the period of December 1, 2022 to December 1, 2023. Variables of interest were identified prior to initiation of the study, and data was collected prospectively through direct entry by clinic staff and extraction from the electronic health record. A total of 543 patients completed GA. 92 cancelled with >72 hours notice, 105 cancelled with <72 hours notice, and 74 failed (no-show) to keep their appointment (12%). There was not a statistically significant association between attendance and gender or language. Patients aged between 6-11 years, with Medicaid insurance, the earliest check-in time (6:30-9:30 AM), and shortest distance travelled to clinic (<20 miles) were less likely to keep appointments. The most frequent reasons for late cancellation or no-show were patient or family illness (53%), fasting violation (4.4%), change in medical status (4.4%), insurance/finances (3%), and transportation issues (1.8%). A high percentage of patients scheduled for GA in this study cancelled with short notice or no-showed for their appointments. Appointment failure was primarily related to anesthesia-related factors such as illness and fasting violation, but logistical issues also impacted attendance.