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Although ambulatory surgery offers patients convenience and reduced costs, same-day cancellation of ambulatory surgery negatively affects patient experiences and operational efficiency. We conducted a retrospective analysis to determine the frequency and reasons for same-day cancellations in an outpatient surgery center at a large academic tertiary referral center. Of 41 389 ambulatory surgical procedures performed, same-day cancellations occurred at a rate of 0.5% and were usually unforeseeable in nature. Focusing on foreseeable cancellations offers opportunities for enhanced patient satisfaction, improved quality of care, and systems-based practice improvements to mitigate cancellations related to areas such as scheduling or patient noncompliance.