Objectives: The operating theatre (OT) is a vital facility that utilises a considerable portion of the hospital's budget; thus proper OT utilisation is essential. Surgical cancellation is a leading cause of OT underutilisation. This study aimed to report the rate and reasons for surgical cancellations and no-shows in a large regional hospital in Oman. Methods: This study took place as part of a retrospective quality management project at the Ibri Regional Hospital, Ibri, Oman. All elective surgical procedures scheduled between January and December 2014 were included. Cancelled procedures were reviewed to determine the reasons for cancellation. Results: A total of 4,814 elective procedures were scheduled during the study period; of these, 1,235 (26%) were cancelled. Patient no-shows were the most prevalent reason for surgical cancellation (63%), followed by surgical reasons (17%); in contrast, OT-associated reasons were responsible for only 2% of cancellations. According to speciality, general surgery had the highest percentage of total cancellations (65%), while ear, nose and throat had the highest rate of surgical cancellations among their scheduled cases (42%). Conclusion: Ibri Regional Hospital had a higher surgical cancellation rate due to no-shows than those reported in the literature. Regular audits, quality management projects and the appointment of a dedicated procedure booking coordinator may enhance proper utilisation of the OT, potentially saving funds, conserving resources and alleviating the burden of cancellations.