Standardized surgical health care and its availability to every person in a community should the objective of a good health system but this is abstruse to complete especially in low and middle income countries. One reason for failure to complete this objective is postponement in elective surgical procedures. It increases burden on hospitals/ healthcare systems as well as misery of the patients and their family members. Patient's stay in the hospitals is prolonged. Hospitals and patients resources are wasted and their expenses are increased. Hospital resources like operation theatre (OT) are underutilized. Surgeons, nursing and other support staff's time is used worthlessly. Patients and attendants face economic and psychological stress. They bear extra financial burden due to stay in hospitals as well as leaves from work. They face more anxiety (42.1 %) and depressive disorders (26.3 %). Patient's health and outcome may deteriorate especially in cardiac, thoracic and cancer patients or in severe category or moribund patients waiting for their surgery.

Pakistan's health care system is based on public and private sector. Public sector health setups provides most facilities free of cost to the community. It is based on primary, secondary and tertiary health care setups. But they are not well integrated and proper referral system to secondary and tertiary health care is weak. Patients are unduly referred to tertiary care hospitals in more than their expected strengths by private clinics as well as by primary and secondary health care setups . Also because of our weak primary and secondary care system, patients coming to tertiary care setups are not aware of their comorbidities like Hypertension, diabetes, ischemic heart diseases, endocrine and respiratory diseases. We also receive fair number of referred patients from our neighboring country; Afghanistan. Some patients admitted for surgical procedures are postponed and are rescheduled for procedures in later dates, thus putting additional burden upon already overburdened system. The rate of postponement is different in different regions. It is estimated to be in between 9 to 44 %. Reason may be organizational or medical. Elective procedures are cancelled due to insufficient OT timings, non-availability of; anesthetists, blood or beds in ICU, change of plan and medical reasons like respiratory infections, cardiac problems, hypertension and uncontrolled diabetes. Cardiac surgeries, cancer surgeries, cholecystectomies, pediatric surgeries and thoracic surgeries are commonly postponed. In an older study done in 2007 in Abbotabad, Khyber Pakhtunkhwa, Pakistan, the postponement rate was 25 %. Elective procedures were cancelled due to shortage of time (36 %), beds (16.2 %), anesthetists (5.8 %) and medical reasons (31%) . Tertiary care hospitals in Peshawar, Khyber Pakhtunkhwa, Pakistan has increased the OR duration from 06 hours to 08 hours and so it is needed to know the new prevalence of cancellation rate of elective procedures and its causes adversely affecting the patients and hospital.

Rationale of the study: Tertiary care hospitals in Peshawar, Khyber Pakhtunkhwa are overburdened and patients on OT list are frequently postponed. Operating room timings has been increased but no recent data is available regarding actual postponement rate and possible causes in this region. The need is felt to assess the problem and suggest recommendations to decrease patients' sufferings and improve hospital workings.

Objectives: To assess the risk factors and postponement rate of elective surgical procedures on the same day of surgery in public sector tertiary care hospitals in Peshawar, Khyber Pakhtunkhwa, Pakistan.

Postponement is defined as cancellation of scheduled elective procedure on the day of operation.