Canadians continued to face longer wait times for joint replacements and an array of cancer surgeries as the COVID-19 pandemic progressed, a new report shows, putting further pressure on hospitals and provincial governments to tackle the backlogs — all while the country grapples with a healthcare staffing crisis and an aging population.
Released on Thursday, fresh estimates from the Canadian Institute for Health Information (CIHI), an independent, not-for-profit organization that provides data on Canada’s health-care system, suggest major dips in surgeries in the first two years of the pandemic continued to have a ripple effect by 2022.
“The most recent data shows that while the monthly number of scheduled surgeries is nearing pre-pandemic levels, this is insufficient to clear the backlog and improve wait times,” reads the CIHI report.
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There were close to 36,000, or 20 per cent, fewer knee replacements performed nationwide between April 2020 and September 2022, compared to pre-pandemic levels. Hip replacements weren’t far behind, with 12,000, or 11 per cent, fewer procedures performed during the same period.
Those drops translated to longer waits: In 2022, only around half of patients had a knee replacement within the recommended six-month time frame, versus 70 per cent before COVID hit, while fewer than 60 per cent of people had hip replacements within the recommended time frame, compared to 75 per cent pre-pandemic.
The data shows “catching up has been more challenging for joint replacement surgeries, which are primarily performed in hospital operating rooms, than for cataract surgeries, which can be done in day procedure rooms or community clinics,” the report continued.
Tracy Johnson, CIHI’s director of health system analytics, said widespread surgery cancellations in 2020, followed by closures during later waves of COVID, all contributed to the backlog. Ongoing staff shortages in hospitals are making the problem worse, she said, coupled with higher demand for joint replacements in recent years due to Canada’s aging population.
“The particular surgeries that are farther behind are those that we call ‘scheduled’ surgeries. They’re ones that are not life-threatening,” continued Johnson, noting that people’s quality of life and ability to work are often still impacted in the meantime.
‘Every hospital is struggling’
It’s a feeling Julia Barbagallo knows well.
Despite being diagnosed with osteo-arthritis — a degenerative joint disease — a decade ago, the Laval, Que., resident tried to maintain an active lifestyle, doing activities like CrossFit, jogging, hiking and martial arts.
But as her condition worsened, her mobility became more limited. Now, at age 55, she requires a cane to walk and says her hip is in constant pain. “It goes from the groin to the hip to the back, inside the hip, down the knee,” Barbagallo explained. “It’s always moving and it keeps me awake at night.”
One surgeon told her the wait for a hip replacement could be a year and a half; another said it would be a year. Barbagallo and her husband are also exploring a faster route to surgery at a private clinic, at a cost of roughly $30,000.
“My health is deteriorating, basically, if I don’t do this as soon as possible,” she said.
Dr. Thomas Forbes, surgeon-in-chief at one of the country’s largest hospital facilities — the University Health Network (UHN) in Toronto — said clinicians feel the pain of patients stuck waiting and are trying to tackle backlogs as best they can.
The number of patients in UHN’s own surgical backlog is now close to 5,000, he said.
“We’re operating at close to 120 per cent of operating room capacity,” Forbes continued. “We’re opening up additional operating rooms on the weekends. We’re opening up other care areas such as procedure rooms to act like operating rooms to deal with some of this backlog that also allows us to try to meet the priorities of some of our more intensive, more emergent care.”
Various levels of government are also making broad moves. Federal health-care funding directed to the provinces includes $25 billion earmarked for several priority areas such as backlogs and health-care staffing.
Some jurisdictions are also shifting more to privatization, including Ontario’s plan to reduce surgical wait-lists by shifting more procedures to privately run for-profit clinics — an approach mired in controversy as some medical experts suggest it will likely increase the true cost to taxpayers and could even worsen wait times.
It’s all a challenging balancing act. The bottom line is the current crunch could lead to long-term strain, Forbes said, as hospitals are still juggling all the other patient needs, from cardiovascular care to neurological issues to transplants.
“The reality is, I think every hospital is struggling somewhat with their capacity,” he said.
Dr. Pierre Guy, president-elect of the Canadian Orthopedic Association, says the system already had a problem before the pandemic, with an estimated 160,000 or more Canadians now waiting for orthopedic operations and roughly half of those involving knee or hip replacements.
“We have a crisis,” he said.
It will take innovation and an all-hands-on-deck approach to ensure more patients get the care they need, Guy said, noting that will require an ongoing focus on staff recruitment and retention to make up for the health-care workers who left the profession during the pandemic.
“We can’t leave the people who have pain every day, who can’t go back to work, who can’t pay their bills,” he said. “We need to provide care for them. We need to be creative.”
Cancer surgeries delayed a day or more
High-priority cancer surgeries faced delays last year as well, though the lags were more minimal, CIHI data shows.
Between April and September 2022, the number of breast, bladder, colorectal, lung and prostate cancer surgeries performed was about 1,000 — or two per cent — fewer than in the same period in 2019. (The data didn’t include figures from Quebec.)
During that same time frame, CIHI’s analysis suggests that dip translated to roughly half of Canadian patients waiting one to three days longer for most of those procedures, and about 12 days longer for prostate cancer surgery, compared with pre-pandemic wait times.
“On an individual level, if we were scheduled for surgery on a Monday and your surgery was changed to a Tuesday, that might not feel necessarily significant to you,” said CIHI’s Johnson.
“So it’s tough to tell whether those one or two days are actually affecting patients at this point in time.”
It does, however, add another layer to ongoing concerns over delays to screenings and surgeries that could result in more Canadians experiencing life-threatening bouts of cancer in the years ahead, as CBC News has previously reported.
One earlier review of Ontario’s breast, lung, colon and cervical cancer screening programs showed that in early 2020, there were initially just over 951,000, or 41 per cent, fewer screening tests conducted compared with the year before — a number that then stayed lower than pre-pandemic levels.
Last year, scientists warned the drop in screenings could mean fewer invasive cancer diagnoses, delays in treatment, and more risk to patients’ health, long before surgery is even on their radar.
No ‘quick fixes’
Oncologist Dr. Timothy Hanna, a clinician scientist at the Cancer Research Institute at Queen’s University in Kingston, Ont., said that’s still his biggest concern.
“I am also concerned about those that have yet to be diagnosed with cancer that developed during the last several years. We have yet to see what effect these delays will have on the excess number of advanced cancer diagnoses in Canada,” he continued, in an email exchange with CBC News.
“International evidence for breast cancer suggests early trends toward more advanced cancer diagnoses during the pandemic.”
Overall, to tackle backlogs going forward, the provinces and territories will need to “exceed pre-pandemic surgery numbers,” the CIHI report stressed.
Johnson said the organization will continue working with the provinces to collect information on the extent of ongoing surgical backlogs, including more focus on current wait lists rather than retrospective data.
Federal funding to the provinces, efforts to recruit more staff, and better data collection are all pieces of the puzzle, but the challenge is going to be that “these things all take time,” she said.
“I don’t think there’s any quick fixes.”