Background: Elective surgical case cancellation refers to any surgical case that is booked into the operation theatre list on the day prior to surgery, but is not operated upon as scheduled [1]. The reasons for cancellation of elective surgical cases are many; they are as unique as they are similar. Aims and Objectives: The study aims to assess the magnitude of elective case cancellation at our hospital. This study tries to delineate the reasons for elective case cancellations across all surgical departments. The study aims to suggest necessary steps to alleviate the problem. Methodology: This is a prospective observational hospital based audit done between 23rd February 2012 and 5th May 2012. Observations and Results: The total number of elective cases booked into the operative list during the study period was 725, of which 197 (27.2%) was cancelled on the day of surgery. General surgery had the highest percentage share of total cancellations at 54.8%, followed by obstetrics gynecology (16.2%), orthopedics (13.1%), ENT (9.1%), urology (3.5%), pediatric surgery (2%), CTVS and neurosurgery (0.5% each). There were 9 cases that were cancelled more than once. They commonest reason for case cancellation was list over run (73%), followed by lack of patient fitness (14%). Discussion: Case cancellations on the day of surgery lead to underuse of OT__ampersandsignrsquo;s, increases waiting period for the patients, frustration and mental stress to the patients and their families, and increases cost and wastage of hospital consumables [1-6]. Cancellation of booked elective surgeries is a common problem across all hospitals in our country and around the world. The incidence of cancellation of elective surgical operations has been reported in literature to range from 20% to 40% [3, 5, 7-10]. Improving the scheduling and admission procedure is of paramount for better use of hospital resources [16].