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Cancellation of operations increases theatre costs and decreases efficiency. We examined the causes of theatre cancellations in general surgery.The Beaumont hospital database (ORSUS system) and theatre records were examined retrospectively between April 1997 and March 2002. The number and causes of theatre cancellations, the number of emergency admissions and their length of hospital stay were studied.The number of elective operations cancelled between April 1997-March 1998 and April 2001-March 2002 were 368 and 427 respectively. ‘No bed' was the reason for theatre cancellation in 114 (31.0%) cases between April 1997-March 1998 and this increased to 267 (62.5%) cases between April 2001-March 2002.Between April 1997-March 1998 and April 2001-March 2002, general surgical emergency admissions decreased by 6.74% (3,116 to 2,906), and emergency surgical admissions across the specialties decreased by 2.02% (4,002 to 3,921). In the same time interval, general medical emergency admissions rose from 4,195 to 5,386 (a 28.39% increase), and emergency medical admissions across the specialties rose from 5,401 to 6,689 (a 23.84% increase). General surgical bed days for emergency admissions fell between April 1997-March 1998 and April 2001-March 2002 from 28,839 to 26,698 (7.4% decrease). There was a similar decrease from 38,188 to 36,004 (5.7% decrease) for all surgical specialties. Total bed days necessitated by general medical emergency admissions increased from 53,226 to 61,623 (15.8%). Across the medical specialties, an increase from 71,590 to 82,180 bed days (14.79%) was seen.Elective surgery cancellation is a significant problem with far-reaching consequences. While multifactorial in aetiology, increased bed usage by medical specialties is one important factor. This study has implications for doctors, training, administrators and patients.