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Background: In clinics, appointment no-shows waste healthcare resources. This study aimed to identify behavioral factors that affect patient attendance, especially those related to rescheduling. Methods: A retrospective study was conducted on 20,386 appointment records for 6,252 patients in an outpatient specialty clinic at a women’s and children’s hospital in Singapore over 34 months (January 2012–October 2014). Multivariate logistic regression was used to analyze the influence of independent variables on appointment no-shows. Results: The average no-show rate of the study population was 28.87%. Patient historical behaviors were significantly associated with appointment attendance. In particular, a larger number of previous visits, more historical no-shows, more historical rescheduling events initiated by patients, and more reschedulings initiated by the clinic for the current appointment were positively associated with no-shows. Notably, the number of previous visits was found to exhibit a significantly diminishing marginal effect on no-show rates. Further analyses suggested that for appointments rescheduled by the clinic, subsequent rescheduling by patients was associated with a reduced risk of no-shows. Conclusions: No-shows were more common in patients who missed more historical appointments or had their appointments rescheduled more frequently. Encouraging patients to reschedule their own appointments could be an effective measure to reduce no-shows. However, the benefit of patient-rescheduling decreased if patients rescheduled appointments repeatedly.

Laparoscopic pancreatectomy has evolved from resection of benign lesions to the treatment of malignant lesions without compromising patient safety and oncologic principles. Driven by the technical shortcomings of laparoscopic surgery, robotic pancreatectomy is the latest development in this evolution. Presently, there are limited but increasing amount of data comparing the outcomes of the various approaches for pancreatectomy: robotic versus laparoscopic and open pancreatectomy. Most studies to date are single large institutional retrospective case series or case-control studies reporting on the safety and feasibility of robotic pancreatectomies but most fail to address key issues like cost-benefit ratio and selection biases. Hence, presently, there is only low level evidence from retrospective studies supporting the use of robotic pancreatectomy. These studies have demonstrated that robotic pancreatectomy is safe and feasible with outcomes at least comparable to conventional laparoscopy and open surgery. There is some evidence suggesting that robotic surgery may decrease the learning curve and conversion rate in minimally invasive pancreatic surgery. Further research is needed to evaluate and compare the effectiveness of robotic pancreatectomy with conventional laparoscopy and open surgery.