N.S. surgery backlog may take 2 years to clear after COVID cancellations

It will take more than two years to clear a backlog of hip and knee replacement surgeries in Nova Scotia created, in part, by the COVID-19 pandemic, according to newly released records.

By September 2021, 78 per cent of the surgical backlog had been completed and the remaining procedures were rescheduled or in the process of being rebooked, according to a briefing package prepared for the Minister of Health and Wellness. CBC News obtained it through an access-to-information request.

At the beginning of the summer, only 43 per cent of surgeries had been carried out, rescheduled or removed from the wait list.

The wait for many surgeries in Nova Scotia is still much longer than national benchmarks, but the records show that for many patients, the wait will still be long, even for "priority procedures."

Though the national goal for cancer care is a 10-day wait, the briefing note described the following waits for various types of surgeries:

• 36 days for breast cancer.
• 46 days for lung cancer.
• 55 days for colorectal cancer.
• 84 days for bladder cancer.
• 112 for prostate cancer.

It said it's taking about 251 days to complete cataract surgery, compared to the desired 112 days (16 weeks).

The benchmark to complete knee and hip replacements is 180 days, but patients in Nova Scotia are waiting an average of 510 days for a hip replacement and 619 for a knee replacement. The records state $15 million is going toward increasing "orthopedic support for hip and knee surgeries" to try to align the wait times with the national benchmark.

Cindy Connolly, a director at the Nova Scotia Health Perioperative (Surgical) Services Network, said in a statement to CBC that it's a priority for the health authority to complete more surgeries and work is underway to figure out the "best approaches to manage our backlog of surgical cases and meet wait time targets."

Though the first and third waves of the pandemic impacted surgeries the most, Nova Scotia Health said there have also been reductions last summer into the fall "due to staffing challenges and higher than usual demands for hospital beds," said Connolly.

"These are fairly common pressures which periodically affected surgical capacity pre-COVID-19 and unfortunately many of these issues have been exacerbated by the pandemic," her statement said. 

14% drop in surgeries

Data compiled by the Canadian Institute for Health Information (CIHI) shows that after the start of the pandemic, the average number of surgeries performed in Nova Scotia fell by about 1,100 a month, or 14 per cent compared to the 2019 monthly average. Nationally, there was an 18 per cent drop in surgeries.

In Nova Scotia during the pandemic, in comparison to 2019, there were on average about:

• 6 per cent fewer cardiac surgeries a month.
• 6 per cent fewer cancer surgeries.
• 24 per cent fewer hip and knee replacements.
• 9 per cent fewer cataract surgeries.

There were an average of 6,568 procedures completed a month between March 2020 and June 2021, compared to 7,628 in 2019.

Learning from the first wave 

During the first wave of the pandemic — between March and June of 2020 — hospitals expected lots of COVID-19 patients and cancelled procedures to make room.

In Nova Scotia, that meant the number of surgeries performed in April 2020 plummeted to 1,978, meaning about three-quarters were cancelled. That month, there were 35 per cent fewer cardiac surgeries and 33 per cent fewer cancer surgeries. The downward spike also affected the overall averages for the rest of the pandemic period.

Tracy Johnson, director of health system analytics at CIHI, said in general, most hospitals tried to prioritize cancer and cardiac care, and it was less urgent surgeries that got pushed back. Delaying surgeries like knee and hip replacements can still take a considerable toll, Johnson said.

"It's not life-threatening, but it certainly affects people's quality of life. And if you can't function because you're in pain, you may not be able to work," she said.

Since the massive demand for respirators and ICU beds didn't happen as anticipated during those early months of the pandemic, it allowed hospitals to start playing catch up in the summer of 2020, said Johnson.

"Hospitals learned a bit of a lesson, just around what they could turn off, how fast they could turn it off and how fast they could turn it back on. And very possibly, they didn't need to close everything down as quickly," she said.

Johnson said the ongoing concerns about COVID-19 did result in many hospitals leaving a 10 per cent capacity buffer, in the event of needing to deal with emergencies including COVID patients, who were admitted in greater numbers and with worse symptoms amid subsequent waves of the pandemic.

Not all surgeries cancelled

Johnson said it's possible some of the decline in surgeries was the result of people not requiring care and others may have put off seeking treatment.

She said the full context of the numbers will only become clear with time, for instance, if people start presenting with cancers at a more advanced stage because they avoided seeking treatment during the pandemic. Some doctors in Ontario have already reported seeing this in kids.

But she said it's also possible that public health measures may have reduced admissions related to non-COVID respiratory issues and even heart problems.

"The other thing we don't know is were cardiac conditions, were some people better off because they were home, they were doing less, they had less stress in their lives, other than their mental health was crap because of all that was going on," Johnson said.

Wait list hasn't changed much

Nova Scotia Health said about 3,400 surgeries were cancelled in the first wave, but since then all but four per cent have either been completed or resolved.

It said that as a result of the third wave that started in April 2021, as well as staffing challenges and access to surgery beds, a further 8,857 procedures were postponed this year. Nearly half of those affected surgeries have since been completed. Another quarter are no longer on the wait list "for a variery of reasons" and while four per cent have been rescheduled, about a quarter of patients are still waiting.

Despite the overall reduction in surgeries, Nova Scotia Health said the number of people approved by a surgeon and waiting for surgery has not changed substantially since the pandemic. As of October, 25,118 people were on the wait list for surgery, only 122 more than two years previously.

But the health authority said it's monitoring the wait list closely because it's possible fewer people sought treatment or received the necessary consultations that would put them on the wait list.

Staffing makes catchup challenging

In Nova Scotia — as in hospital across the country — catching up may also be a challenge due to the ongoing strain on the health-care system, Johnson said.

"It's finding the physicians and the nurses to be able to do those surgeries who aren't already tired," she said.

"You can switch from inpatient to an outpatient procedure, then you have to probably have a better chance of doing things quickly and getting through some of those surgeries as well."

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