As SickKids surgical backlog grows, family waits 3 years for crucial procedure

Shortly after George Michelis was born in August 2019, doctors discovered a birth defect — the opening of his urethra was located along the shaft of his penis, rather than at the tip.

While somewhat common and not life-threatening, medical experts say hypospadias should ideally be operated on within six to 18 months to correct the position of the urethra. That's because patients can develop physical and psychological problems if it's not treated. 

George's parents, Stefanos Michelis and Peggy Karagianis, brought him to see a specialist that November at the urology department of the Hospital for Sick Children, where they were told he was a candidate for surgery.

"They said they would get back to us with the surgery date within six months to a year," Michelis said. "But the pandemic hit in March of 2020 and ever since then, we've been kind of in a black hole."

That's left George to languish for the past three years on a waiting list for hypospadias surgery at SickKids. He's one of 698 children waiting for the procedure, according to SickKids. Because hospitals are making emergency and urgent procedures a priority, non-urgent patients like George can linger at the bottom of the list for months, or even years, without knowing when their surgery will take place. 

The family's long wait is emblematic of what many at SickKids are going through, as the number of children waiting for operations continues to grow. According to the hospital, there were 6,021 patients in line for all kinds of pediatric surgeries at SickKids as of Oct. 31 — a 280 per cent increase since 2017.

"There's a huge volume of children that need surgery and we just don't have enough resources to take care of all of them," said Dr. Simon Kelley, associate chief of perioperative services at Sick Kids. 

"This is a situation that's evolved over many, many years and COVID was really probably the straw that broke the camel's back."

Kelley said the hospital is dealing with a shortage of surgeons, specialized staff who support surgeries and recovery, and operating room time.

"You're in Canada. You don't expect this was going to happen here to us," said Karagianis. "It's disappointing actually, and disheartening."

Only 1 doctor regularly performs hypospadias surgery

Hypospadias affects approximately one in 150 to 300 male babies born worldwide, according to the SickKids website. If not treated, patients can develop urinary blockage, reproductive issues or psychological problems as they grow older.

Kelley said SickKids has three pediatric urology surgeons capable of performing hypospadias surgery, but only one regularly performs it. The other two focus on different procedures. 

"A comparable city across North America would have 10 to 12 specialist urology surgeons for children and that's for a population of the same size," Kelley said.

Meanwhile, the waitlist for hypospadias surgery has been growing. 

• Are you a parent whose child is part of Ontario's surgical backlog and you'd like to talk about it? Reach out at torontotips@cbc.ca

According to a letter from the urology department Michelis shared with CBC News, there were "over 500" patients on the wait list in July. A follow-up letter from George's urology surgeon in mid-October stated "over 600" were on the list at that time. Now, just two weeks later, that number has grown by nearly 100.

This week, after CBC Toronto started looking into the family's situation, George received a January 2023 date for his surgery.

"We're just ecstatic that that George is going to be taken care of," Michelis said. "I feel guilty that we're going through and there's other kids waiting."

'System-wide' change needed, SickKids doctor says

The number of children waiting for surgeries at SickKids continues to grow despite the hospital performing around the same number of surgeries last year as it did before the pandemic. The hospital has introduced a volunteer weekend surgery program, improved its waiting-list system and brought in an ethics team to make decisions about which patients should be a priority.

Kelley said "system wide" improvements are necessary to increase capacity across the health-care system, including training and hiring more surgeons and specialized support staff and working with regional hospitals and community clinics to perform more surgeries.

"We need a solution that involves not just individual hospitals, but networks of hospitals across the region and across the province," Kelley said.

In a statement, Ontario's Ministry of Health said it's investing investing $300 million in 2022-23 in the province's surgical recovery strategy, for a total of $800 million since the start of the pandemic.

"Our Surgical Recovery Strategy will ramp up surgeries and procedures, address the long waiters, and to support and optimize the post-acute pediatric care pathway with a focus on areas with the greatest reduction in services due to the pandemic," the ministry said.

The province said its added 3,500 hospital beds, more than 11,900 health-care workers and deployed more than 1,000 internationally-educated staff to hospitals so they can gain the language proficiency and practical experience they need to work as practising nurses.