Pandemic ups and downs likely still compounding surgical backlogs

About 600,000 fewer surgeries were performed across Canada since the beginning of the pandemic

By Laura Osman in Ottawa

The ups and downs of pandemic waves continue to affect wait times for elective surgeries in Canada, adding to concerns about mounting backlogs as provinces ease restrictions, new data from the Canadian Institute for Health Information shows. 

The new report shows hospitals and health systems have gotten better at weathering spikes of COVID-19 infection since the virus first struck the country in early 2020. But the number of surgeries performed still fluctuates with each pandemic wave, compounding backlogs every time.

“From an ongoing perspective, you can expect to see challenges likely across all provinces, because even if you can ramp up to what you were pre-pandemic, get your waits down, you still have that backlog you’re trying to make your way through,” said Tracy Johnson, director of health system analytics at CIHI. 

When COVID-19 first arrived in Canada, hospitals shut down all but the most urgent surgeries to cope with the massive influx of patients.

That meant patients waiting for important, but elective, procedures like joint replacements were left to tough it out until hospitals were able to get to them or their condition became an emergency. 

About 600,000 fewer surgeries were performed across Canada since the beginning of the pandemic, the institute says. About a quarter of those were joint replacements and cataract surgeries. 

CIHI looked at data related to select surgeries for the first 18 months of the pandemic, which predates the Delta, Omicron and BA. 2 waves.

For hip and knee replacements, only about 51 per cent of patients across Canada were treated within the recommended time frame of 182 days in the first months of the pandemic, compared to 71 per cent before the pandemic began. 

Those numbers have gradually improved to 62 per cent of patients treated within the recommended time between April and September 2021. 

What the numbers don’t convey is the impact on those who are facing long waits for care, said Dr. Katharine Smart, Canadian Medical Association president.

Particularly for orthopedic conditions, patients can spend months or years in serious pain.

“Are you able to keep working? Are you able to see your family? Are you able to face each day without significant suffering?” Smart said.

The numbers also don’t explain why wait times have improved since the pandemic began. It mainly comes down to health workers taking on more hours and hospitals taking on more operating time, said Paul-Émile Cloutier, president of HealthCareCan — a national organization representing health-care organizations and hospitals across Canada.

“I think it’s not going to be sustainable too long,” he said. “I don’t think that you can continue to rely on the goodwill of Canada’s overburdened and overworked health workforce to fill the cracks in our system.”

Delays in preventive care, specialist consultations and pre-surgical tests means more people may need surgery, CIHI suggests, which could add to wait times as more patients are added to the backlog.

More urgent procedures like hip fractures and cancer surgeries were shown to have been prioritized during the pandemic, and wait times have not been significantly affected since the onset of COVID-19.

After the data for the study was collected, Canada was struck by the biggest wave of COVID-19 yet. The Omicron wave stressed health systems by putting a massive number of patients in the hospital and even more hospital staff into isolation. 

Even now, as the latest wave slows down, hospitals are still stretched thin, chief public health officer Dr. Theresa Tam said at a briefing last Friday.

“Weeks of COVID-19 resurgence, including widespread illness and health-care worker absenteeism, has contributed to prolonged impacts on the health system,” Tam said.

Those impacts, including delayed surgeries, have likely added to the backlog since the last round of data was collected, Johnson said. 

That’s on top of staff shortages, which further exacerbate the backlogs and make it difficult to ramp up the number of surgeries, Smart said.

The federal government has dedicated a $2-billion lump sum to help provinces work through their pandemic-related surgical backlogs, but provinces have said that without long-term funding, there are limits to what that money can achieve. 

The money is helpful in terms of temporarily expanding the system and booking extra operating-room time, but it won’t be enough to solve the problem for good, Smart said.

Cloutier and other health industry leaders have encouraged the federal and provincial governments to come together on a more sustainable solution to the systemic issues afflicting the health system and contributing to backlogs. 

The study also looked at cataract surgery and wait times for MRI and CT scans. Cataract surgery took a hit during the early days of the pandemic, but in April to September 2021, 66 per cent of patients were treated within the recommended time frame. That’s nearly back to the pre-pandemic level of 69 per cent.

Johnson said that’s mainly because cataract surgery is typically performed in a clinic, rather than a hospital. 

Waits for MRI scans have actually improved nationally by four or five days compared with the pre-pandemic period, though there was a huge variation between provinces. Waits for CT scans remained about the same.  

This report by The Canadian Press was first published May 10, 2022.

Feature image – A doctor prepares for a surgical procedure at a hospital in Washington on June 28, 2016. The latest data release by the Canadian Institute for Health Information shows Canadians still struggled with long wait times for surgeries last year compared to the days before COVID-19. THE CANADIAN PRESS/AP-Molly Riley.

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