Backlog of surgeries worsened by COVID-19 shutdown

The president of the New Brunswick Medical Society says the serious backlog of elective surgeries in the province has been made worse by COVID-19.

"We're aware of a large number of patients whose procedures have been delayed because of the shutdown for the pandemic," said Dr. Chris Goodyear.

Geri Geldart, a vice-president with Horizon Health Network, said as of March 13 when non-urgent surgeries were put on hold, there were 16,353 patients waiting for surgery. By July 29, that number had risen to 16,564, an increase of one per cent.

In the Vitalité Health Network, Johanne Roy, vice-president of clinical services, said 4551 patients were awaiting surgery on March 13.  As of May 31, the number had grown to 5031 patients.

While Horizon Health could not confirm the number of people waiting for orthopedic surgeries, Goodyear said it numbers in the thousands and has the longest wait times.

"Certainly it wasn't unheard of for thousands of patients to be on the wait list for joint replacement surgery in this province," he said.

With none of those surgeries done during the three-month shutdown, Goodyear said he wasn't surprised by the number.

Wait times 

On average, nine out of ten patients waiting for a knee replacement received one in 558 days, or 1.5 years. The longest wait is at the Dr. Everett Chalmers Hospital in Fredericton with a wait time of 738 days or 1.9 years and the shortest time was at the Edmundston Regional Hospital with a wait time of 260 days. 

Those waiting for hip replacements waited an average wait time of 525 or 1.4 years. Again, nine out of ten surgeries were completed at the Edmundston Regional Hospital with the shortest wait time of 278 days and the longest at Moncton Hospital with a wait time of 653 days or 1.7 years. 

"It's very hard to catch up despite our best efforts because although surgeons were not operating during the pandemic, other members of the health-care team that we work with were working," he said.

Goodyear said operating room nurses and cleaning staff were assigned to work in other areas of the hospital and are entitled to take vacation time and get a respite when they can.

When asked about keeping operating rooms open longer each day and even on weekends to help catch up on the backlog, Goodyear said it would be hard to get people to work after hours because it involves more than just the surgeons.

"We had a system that was working at capacity prior to the pandemic, so there was very little leeway built into the system," he said.

Meanwhile, on average the wait time for any surgical procedure in New Brunswick is 310 days, with the longest wait at Sackville Regional Hospital and the shortest at the Upper River Valley Hospital. 

By June, surgeons at Horizon Health had reached their normal daily volume of surgery performed and are maintaining that level of operation, Geldart said.

"Across Horizon, operating rooms in our regional hospitals run seven days a week. We provide scheduled surgery Monday to Friday, while providing emergency surgery 24 hours per day, seven days per week," she said.

Roy said some of the steps being taken at Vitalite include using the surgical access registry effectively, having more operating rooms available this summer and continuing the orthopaedic surgery access program at the Dr. Georges-L.-Dumont Hospital. 

"Over the past few weeks, every effort has been made at both the provincial and local levels to increase our surgical capacity while maintaining a hospital occupancy rate of 85 per cent." 

Goodyear adds they also don't want to burn out health-care workers because that would lead to further delays in the future.

He said he's had conversations with Health Minister Ted Flemming about the topic.

"He is quite aware and quite concerned about the problem," said Goodyear. "And again, his frustrations are the same as ours in terms that we had a system that was at capacity prior to the pandemic, so there is no easy solution in trying to deal with the backlog here."

Goodyear said one option that the government and the regional health authorities are looking at is trying to maximize the use of operating rooms in smaller hospitals across the province.

New initiatives

Geldart said the health network is looking at new initiatives to increase operating room volumes. A new orthopedic surgery initiative is being launched in Saint John in September.

"This is a $4.2 million initiative funded by government and has a target to complete 900 joint replacements each year," she said.

Geldart said while they are exploring other initiatives, many require additional specialized staff and physicians "that are in high demand, but limited in supply."

Goodyear said people waiting for non-elective surgeries should stay in touch with their surgeon. If things worsen, make them aware.

He's concerned about a potential second wave of COVID-19 in the fall.

Keeping a second wave as small as possible is important to allow the province's health-care system to continue working without shutting down operating rooms.

"We really have to be aware that the system can't take a shutdown of three months as we just went through," Goodyear said.

Bruce Macfarlane, spokesperson with the Department of Health  said a provincial surgical advisory group was set up when the pandemic hit, composed of department officials, staff and physicians from both regional health authorities. It started to address issues related to wait times for surgical services and the planning and provision of surgery in New Brunswick during the COVID-19 pandemic

"The group is finding ways to increase volumes of surgery where we can reduce the wait list as well as continue elective surgeries should New Brunswick face another wave." 

Macfarlane said those efforts to get back to full capacity are proving successful.

"In June of 2020, surgery volumes were 98 per cent of 2019 volumes. In July 2020, surgery volumes were actually 103 per cent of July 2019 volumes."

Macfarlane added the group has been mandated to "identify strategies to make lasting improvements that will reduce surgical wait times." 

The strategies include maximizing use of all operating rooms and surgery resources in the province and expanding the use of virtual technologies and telemedicine for pre- and post-operative assessments and care.