Surgery wait times change little in 5 years

About eight in 10 Canadians received priority surgery such as hip and knee replacements in a timely manner, but large regional variations exist, according to a new five-year report.

Tuesday's report from the Canadian Institute for Health Information focuses on the five priority areas set by first ministers in 2004 using timeframes based on clinical evidence:

• Knee replacement — 182 days.
• Hip replacement — 182 days.
• Hip-fracture repair — 48 hours.
• Cataract surgery — 112 days.
• Radiation therapy — 28 days.

"Since 2010, there has been little change in the proportion of people treated within the benchmarks, with the exception of hip-fracture repairs, which increased from 78 per cent in 2010 to 84 per cent in 2014," the report's authors said.

Despite the increase in the number of procedures from more patients needing surgery, wait times remained consistent.

• Priority surgeries demand adds to wait time pressure
• Medical wait times up to 3 times longer in Canada 

Nationally last year, knee-replacement surgeries were performed within the clinical benchmark 79 per cent of the time on average, down from 80 per cent in 2010.

About 83 per cent of hip-replacement surgeries were done within the benchmark. The median wait time of 87 days with the second lowest among peer countries in the Organization for Economic Co-operation and Development after the United Kingdom at 82 days.

"We spend a lot of time in Canada focusing on whether we've got the appropriate benchmarks, and is eight of 10 patients at the moment good enough," said Tracy Johnson, manager of emerging issues at CIHI in Toronto.

"I think by looking at the countries, we get the perspective that we're in the ballpark and particularly not doing so badly."

British Columbia and Nova Scotia were worse than the OECD average for waits for hip and knee replacements. 

Regional variations 

For hip and knee replacements within each province, new data show "considerable variation" in wait times. Quebec, Ontario and British Columbia all had wide ranges, such as a variation of 54 per cent to 98 per cent for hip replacements between the six networks that serve Toronto and its surrounding areas.

Vancouver Island Health Authority and Vancouver Coastal Health also showed variation. For smaller regional health authorities, Johnson noted many are focused on blitzes to clear queues within benchmarks, which could take a year or two to show improvements.

Johnson said information on regional variations could help guide health systems in their decisions about how to organize care. Options include:

• A central intake model in which all patients queue together with the option of waiting for a specific doctor or the first available surgeon.
• Orthopedic assessment centres where multidisciplinary health-care teams ensure the appropriateness of surgery and the right tests are done to free up surgeons' time.
• Removing waste from the system, such as through a lean model common in Saskatchewan and Newfoundland and Labrador.

Cataract surgery patients received their procedure in a timely fashion 80 per cent of the time, compared with 83 per cent in 2010.

Radiation therapy wait times were consistent with 98 per cent of treatments performed within a month.

Demand for specialized care will increase as the population ages and patients with more complex conditions need medical attention, the report's authors concluded.

The institute is working with the provinces to report and compare intravenous chemotherapy wait times.