Wrist surgery tops list of surgical wait times in Nova Scotia

Wait times for hip and knee surgeries in Nova Scotia were singled out by the provincial auditor general in his report last week, but there are worse numbers where those came from.

According to the province's calculations, the wait for wrist surgery is about 50 per cent longer than the wait for hip surgery.

There are 3.5 times as many people waiting for jaw surgery as there are for knee replacement.

In his latest report, Auditor General Michael Pickup focused on knee and hip surgeries — both very common — because there are national benchmarks for the wait lists of both procedures. Nova Scotia is doing badly judging by those two benchmarks, waiting longer than other Canadians, he wrote.

A list compiled by the Department of Health with the 10 longest wait times for surgery in Nova Scotia currently show hip and knee procedures are near the top. However, they make up only two of seven orthopedic surgeries with comparatively long waits, and three non-orthopedic surgeries also made the top 10.

After mastectomies, most women wait up to 16 months for breast reconstruction, while people who need surgery to repair crossed eyes wait about 15 months.

Total wait can be much longer

From a patient's perspective, the total wait can be much longer than the list shows. The province and the auditor general count a wait time from the date each patient meets with a surgeon and is cleared for the procedure. 

The wait to get that first appointment with the surgeon, after being referred by another doctor, can be years.

In 2013, the province's only specialized foot and ankle surgeon said more than 3,000 patients were waiting up to a decade to meet with him. None of them were counted in the official list for foot surgery, which has 11 names as of Dec. 1 and an 18-month wait.

However, the official numbers are also affected by demand from patients outside Nova Scotia who need specialized care unavailable in their home provinces. When it comes to jaw surgery, the Capital District Health Authority said last year that about 30 per cent of people waiting were from outside the province.

A spokesman for the Department of Health said there has been progress in the last two years.

Of about 80,000 surgeries performed annually in the province, about 95 per cent happen within a year of meeting with the surgeon, said Tony Kiritsis.

The number of people waiting more than a year has dropped by about a quarter since 2012, he said.

Specialist recruited

The department has invested about $4.2 million this year to do more hip and knee surgeries and to recruit a second foot and ankle specialist, said Kiritsis. That new specialist hasn't yet started work.

A special province-wide committee is also trying to make the surgery system more efficient, though, "It is still early," Kiritsis said.

In his report, Pickup wrote that operating rooms in parts of the province are sometimes lying empty despite huge demand. When they are booked, it's often not according to which waiting list shows greatest need.

Some of his findings included:

• At the Victoria General and Halifax Infirmary, from last January to June, operating rooms were unused 29 per cent to 16 per cent of the time.
• At the Dartmouth General in June, the operating room was unused 20 per cent of the time. Meanwhile, different surgeons had different access, leading to inequality for their patients. Half of one surgeon's patients waited almost a year for surgery while a colleague's patients waited only about two months.
• At Annapolis Valley Health, operating room time was allotted "based on historical precedent and it has been challenging to implement change due to individual physician preferences," Pickup wrote.