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Patient patience: The long wait for elective surgery in Canada

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Many people across Canada have problems accessing health care, from finding a family doctor to securing a spot on the operating table. In this series, Advancing Health will explore the current health care climate and share expert insights on how accessing care could change. The first installment features Dr. Jason Sutherland and discusses his work on wait times for elective surgery.

It’s been all over the news: wait times for elective surgeries in Canada are long. Advancing Health’s Program Head for Health Services and Outcomes Dr. Jason Sutherland is an expert on the topic and kindly spoke with us about the recent past, present, and future of surgical wait times across the nation.

The pandemic effect

Dr. Jason Sutherland, Program Head for Health Services and Outcomes, Advancing Health

2020 is a year many of us would probably rather forget. But when it comes to surgical wait times in Canada, it can’t be ignored. The COVID-19 pandemic had a negative impact on the already long wait lists for surgeries, with many elective procedures being cancelled or postponed, affecting thousands of people in different ways.

Some patients’ mental health symptoms went untreated or unaddressed, with some experiencing significant symptoms of depression or anxiety, while other patients had to manage their pain and function for longer than expected. A commentary by Dr. Sutherland and colleagues explained that, not only are mental health burdens problematic in themselves, but they can also affect surgical outcomes and length of hospital stay.

In addition, further research by Dr. Sutherland shone a light on how 12-month delays in accessing elective cholecystectomy (gallbladder removal) resulted in a mean loss of 6.4 per cent of the quality-adjusted life years that a patient would have been expected to gain. In other words, the anticipated health benefits for patients were lower than they would be without extended delays to their planned surgery.

Today, we are past the peak pandemic chaos, but how have things changed to improve wait times?

“This is a tough question,” said Dr. Sutherland. “Immediately, following the end of lockdowns, some provinces tried to expedite elective surgeries in a number of ways. First, they offered hospitals more funding to keep operating rooms open longer or on weekends. Second, some provinces have been experimenting with contracting out public surgeries to private surgical centres (e.g., Alberta).”

From the waiting room to recovery room

Unsurprisingly, there’s also a strong relationship between how long someone waits for surgery and their overall health and wellbeing. “We found that patients with higher levels of pain and lower health status were scheduled to wait the longest,” explained Dr. Sutherland. “We need to reconsider precisely how we organize waitlists and triage patients.” 

For patients who make it to the other side of the operating theatre, the impact of wait times may linger.

Looking at post-operative outcomes for elective lumbar degenerative surgery, Dr. Sutherland and his team noted that shorter wait times were associated with more noticeable improvements in physical function. Patients who waited longer did not experience the same gains. In practice, only a small minority of patients receive their elective lumbar surgery by the targeted wait time — just 12.7 per cent had surgery by the three-month mark, and 30.1 per cent by the six-month mark. This research highlights how much work is needed to bring surgical wait times down in order to maximize patients’ health and wellbeing.

Where do we go from here?

Elective surgery wait times are unlikely to significantly improve any time soon, but there are some considerations that could improve or stabilize the mental and physical health of patients who have no choice but to join the queue. Provinces and their hospitals could offer prehabilitation to support post-operative recovery and provide no- or low-cost mental health support services in the lead up to surgery.

“I have two topline recommendations to help reduce wait times for elective surgeries. First, implement evidence-based procedures for reducing wait time, including improving efficiency by introducing pre-consultation triage and centralized referral. Second, we need to fund mental and physical health services to help patients and their families cope with prolonged wait times,” said Dr. Sutherland.

But there is a lot of work still to be done, both in terms of research and policy.

“Research-wise, we need to identify patients most at risk during their prolonged wait. Then, ascertain what services they and their families need,” said Dr. Sutherland. “From the policy research perspective, some insights are needed to understand the barriers to provincial governments and their hospitals implementing evidence-based approaches to managing and reducing surgical demand and wait lists. We also need to determine what difficulties they face regarding implementing programs to fund or provide mental or physical health services, products, or technologies to waiting patients and their families.”

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