Alberta surgeries cut back by 2,800 per month in first 15 months of pandemic

Alberta hospitals performed about 2,800 fewer surgeries per month during the first 15 months of the COVID-19 pandemic compared to pre-pandemic levels, new data shows. 

Data released Thursday by the Canadian Institute for Health Information (CIHI) details the widespread impact of the pandemic on health care in Alberta and across Canada between March 2020 and June 2021.

The most drastic decline in surgeries in Alberta during the first three waves of COVID-19 was recorded in April 2020, when the number of procedures decreased by 68 per cent compared to the same month in 2019.

Only 8,735 procedures were performed in April 2020, compared to 27,043 operations in April 2019. 

April 2020 saw 18 per cent fewer cardiac surgeries in Alberta and 81 per cent fewer high-volume surgeries — including knee and hip replacements and cataract, fracture and hernia repairs.

The surgical delays were widespread, as hospitals reallocated resources to support areas of greatest need, such as intensive care units.

Almost 560,000 fewer surgeries were performed in Canada over the first 15 months of the pandemic compared with 2019, the report says — about 35,000 fewer operations per month.

The largest decline occurred during the first wave while the system prepared for an influx of COVID-19 patients.

Dealing with the backlog, and understanding the full impact on patients, will be difficult, Kathleen Morris, CIHI's vice-president of research, said in a statement.

'Still many unknowns'

"Our data shows that lessons learned from the first wave of COVID-19 resulted in fewer cancelled surgeries in the following two waves," Morris said.

"There are still many unknowns about the effects of COVID-19 on our health systems and on the health of our population — such as what happened to those who didn't seek hospital care or to those whose surgeries or diagnostic tests were delayed." 

Despite fewer surgical procedures taking place across the country, the report suggests that quality of care was maintained during the first two waves of the pandemic by redeploying resources, and by delivering primary care to patients virtually.

Across five provinces where data is available, between 27 per cent and 57 per cent of physician services were provided virtually.

COVID-19 also altered operations outside operating rooms as patients were directed or triaged to treatment elsewhere. Across the country, emergency rooms visits dropped by 9,300 per day on average during the pandemic period compared with 2019.

From March 2020 to June 2021, there was an average increase of about 3,000 additional inpatient admissions a month for respiratory conditions, compared with the pre-pandemic period.

"Each successive wave of COVID-19 saw higher volumes of respiratory conditions and put added pressure on hospitals for beds and specialized resources such as ICU beds and ventilators," the report says.

By April 2021, 87 per cent of respiratory admissions to the ICU were for COVID-19 infections, it says.

"COVID-19 displaced most other common illnesses such as pneumonia and chronic obstructive pulmonary disease (COPD), illnesses that would normally require the same hospital resources."  

In ICUs, from March 2020 to June 2021, there were almost 14,000 more respiratory admissions, compared with the pre-pandemic period. 

By the third wave, the need for ICU care and ventilators among respiratory patients had increased by about 400 per cent. 

In Alberta, the most drastic increase in the number of patients requiring long-term invasive ventilation was recorded in October of 2020, with a 60 per cent increase compared to the same month in 2019.

The report also says residents of long-term care homes have been disproportionately impacted by COVID-19 infections and deaths. Long-term care residents accounted for three per cent of Canada's COVID-19 cases — and 43 per cent of deaths from the disease — during the pandemic's first 15 months. 

'Unintended consequences' 

The report details other consequences of COVID-19, noting an increase in self-harm caused by addictions.

While hospitalizations for most other conditions declined during the first 16 months of the pandemic period , hospitalizations for harms caused by substance use rose by nine per cent. 

The increase, totalling more than 16,000 additional hospitalizations, was largest in the later stages of the pandemic period, between October 2020 to June 2021.

Overall, there were about 190,000 hospitalizations for harms caused by substance use during the entire pandemic period.

"Canadians are experiencing prolonged public health measures during the COVID-19 pandemic," reads the report.

"While these measures are intended to restrict the spread of COVID-19, they may also be leading to unintended consequences."