Across Canada, patient experiences with surgical delays and long waitlists appear extremely similar, particularly for non-life-threatening procedures like hip and knee replacements. Patients can wait months, even a year or more, for a surgical consultation. After that, they may have to wait another year for their procedure.

At the same time, patients often experience increasing pain, reduced quality of life, and negative effects on their personal and professional lives. Faced with unbearable waiting, some patients choose to leave the public health system to join private surgical centers. With this approach, patients end up getting the care they need, but spend their savings on expensive procedures, travel, and missed work hours.

Provincial health systems are seeking solutions, including public and private options, to reduce backlogs that persisted before the COVID-19 pandemic. Population growth, the increasing demands of an aging population and diminishing supply in a depleted workforce contribute to a dilemma that has persisted for more than a decade.

“In Canada, as in many countries, demands on the health care system are increasing exponentially, where (meeting) the needs of a growing and aging population will always be a challenge,” Sean Cleary, MD, chair of general surgery at the University. of Toronto, Toronto, Ontario, Canada, and past president of the Canadian Association of General Surgeons, said Medscape Medical News.

“We’ve been talking about wait times and capacity for a long time, and we continue to look for ways to improve the process,” he said. “How can we provide care effectively, appropriately and efficiently? There is no magic solution, so we must continue to address it.”

Recent surgical delays

To measure progress toward shorter wait times, the Canadian Institute for Health Information (CIHI) looks at annual changes in surgery volumes, hip fracture surgical procedures within 48 hours and waiting times for joint replacements.

Surgical volumes returned to pre-pandemic levels in 2022-23, when 2.22 million procedures were performed. Volumes further increased to 2.33 million in 2023-24, up 5% from 2019-20, according to a report. CIHI Report released at the end of October.

Even as more surgeries are performed, wait times remain longer than what is considered acceptable, particularly for hip and knee replacements, which are among the three most common hospital surgeries common in Canada. By 2023, approximately 62% of these surgeries met the benchmark waiting time of 26 weeks. The proportion varied widely from 28% in Prince Edward Island and 36% in Saskatchewan, to 60% in British Columbia and 77% in Ontario.

“Nationally, wait times for most reported procedures remain longer than before the pandemic, even as procedure volumes have returned to pre-pandemic levels,” said Cheryl Chui, director of the health systems analysis at CIHI.

“Surgical delays can lead to negative health consequences, including worsening medical conditions, increased pain and even death,” she said. “Addressing these delays is critical to improving patient outcomes. »

The private cost of these public queues for medically necessary care can add up, according to one recent report from the Fraser InstituteVancouver, British Columbia, Canada. For example, in 2023, the estimated cost of waiting for care in Canada was equivalent to almost $3.5 billion, or approximately $2,871 for each of the 1.2 million Canadians waiting for treatment. last year.

Fraser Institute researchers found that national median wait times from GP referral to treatment were almost 28 weeks in 2023, compared to 9 weeks in 1993. Additionally, wait times between a specialist appointment and treatment were 13 weeks, or about a month longer. than what doctors considered clinically reasonable, at about 8 weeks.

“That being said, context is important. Even in 2019, patients in Canada waited 19.8 weeks from referral to treatment. In other words, wait times are a structural problem that has been exacerbated by the pandemic,” said Bacchus Barua, study co-author and director of health policy studies at the Fraser Institute.

However, “long wait times for care are not a necessary price to pay to maintain a universally accessible health system. There are at least 30 other high-income countries that share the goal of a universal health system,” he said. “Unfortunately, the current approach in Canada is focused on preserving the (current) system, leaving the patient to bear the consequences.”

Testing Solutions

The COVID-19 pandemic has reduced patient access and increased burnout among healthcare professionals. Provinces have tested various solutions to increase the volume of procedures, reduce wait times and replenish the health care workforce – with varying degrees of success.

In Alberta, Canada, for example, the Alberta Surgical Initiative was created to address surgical delays and reduce wait times for non-life-threatening procedures. During this time, many health care providers migrated from public systems to private surgical centers, exacerbating access problems. New public-private partnerships are expanding the use of surgery centers to offer publicly funded procedures, and a centralized admissions program is helping to increase access to surgeons with shorter wait times. However, waiting lists remain long while high demand persists.

In Ontario, wait times for elective surgeries for the same procedures vary widely from hospital to hospital — up to 15 times in some areas — according to one study. study published in PLOS ONE in August. The authors recommend the adoption of a centralized referral system, which could reduce the first part of the waiting list, as well as teams of surgeons for common interventions, which could pool availability and reduce the second part of the waiting list. the waiting list.

“Most provinces are taking joint measures to reduce longer wait times,” Chui said. “The most important strategy is central admission, where all patients are queued on a single list and given the choice of waiting for a specific doctor or choosing the first available surgeon. »

Provinces also manage operating room hours to increase capacity, monitor waiting lists to ensure appropriate patients are on their lists, and use central case managers to organize procedures surgical, she said. Communication with patients and relevant stakeholders is also essential.

“It is important to note that patients will still wait for elective surgery, and this time is stressful for patients. Reframing wait times as an opportunity to prepare for surgery (prehabilitation) can improve patient clinical outcomes (mental and physical health) and patient experience, which can reduce the burden on health systems,” said Khara Sauro, PhD, head professor and neck health services research at the University of Calgary, in Calgary, Alberta.

Sauro and colleagues studied surgical delays before and during the pandemic in several Canadian provinces. Although some backlogs are being cleared, she noted, wait times for surgeries were a problem before the pandemic and remain a persistent problem today.

“We can’t fix what we can’t measure. It is therefore important to continue to monitor and understand surgical wait times so that we can adapt to the needs of the population,” said Sauro. “However, we need to go beyond measurement and use evidence to inform change. Challenging times breed innovation – this is a great opportunity for policy makers, healthcare providers and researchers to work together to find innovative solutions to the challenge of long wait times for surgical interventions.

Carolyn Crist is a health and medical journalist who reports on the latest studies for Medscape Medical News, MDedge and WebMD.