This article was written by the Canadian Institute for Health Information. Published March 23, 2023. To access the original article, click here.
Have hospitals been able to catch up on surgeries impacted by the COVID-19 pandemic? Are Canadians waiting longer for priority procedures such as knee replacements, hip replacements, cataract and cancer surgeries, and diagnostic imaging? Keep reading to learn about recent trends in surgical volumes and wait times. These findings will inform recovery and planning efforts by health systems to reduce surgical backlogs and deliver more timely care to Canadians.
Decreases in the annual number of surgeries continued in the second and third years of the pandemic, with variations by province and territory
During the first 31 months of the pandemic, about 937,000 (14%) fewer surgeries were performed in Canada compared with before the pandemic. These estimates of the number of and percentage change in surgeries performed since March 2020 were calculated using 2019 as a baseline comparator, with no adjustments for changes in population growth or for other factors.
The largest decrease in surgeries occurred during the first 4 months of the pandemic (March to June 2020), as scheduled and non-urgent surgeries were cancelled or postponed across all provinces and territories in response to public health guidelines. Large decreases also occurred at the national level during the Delta (May 2021) and Omicron (January 2022) waves. Provinces and territories will need to exceed pre-pandemic surgery numbers in order to recover and to reduce surgical backlogs. At the national level, the volume of surgeries has rarely exceeded the number performed before the pandemic except in March 2021 (increase of 7%), March 2022 (increase of 3%) and June 2022 (increase of 4%).
After the first 6 months of the pandemic, the trends and total changes in surgeries varied considerably across the country.
- Provinces such as Prince Edward Island and British Columbia did not experience large decreases after the first 6 months of the pandemic, and the total number of completed surgeries has rebounded to within 0.5% to 7% of pre-pandemic levels.
- Newfoundland and Labrador, Quebec and Manitoba saw large decreases during the Delta and Omicron waves of COVID-19, with between 18% and 21% fewer surgeries overall compared with pre-pandemic numbers.
- This is the first time this ongoing analysis includes Quebec data. At the time of analysis, data included results for Quebec up to March 2022. During the first 25 months of the pandemic, there were about 200,000 fewer surgeries in Quebec, compared with before the pandemic.
Decreases in surgeries were observed across all age groups and for both males and females. Results for the 31-month period also suggest that the pandemic had a greater effect on those living in lower-income neighbourhoods, for whom surgeries decreased to a greater extent.
Decreases in surgical volumes have been the result of many factors including the timing and impact of COVID-19 cases and the health system responses, which included the cancellation of scheduled surgeries. Reduced availability and shortages of health care workers have limited the ability of the system to catch up on surgical backlogs. Throughout the pandemic, health care workers have experienced higher overtime rates and psychological distress, resulting in many taking early retirement or leaving health care. Ongoing staffing shortages continue to hamper efforts to reduce the backlog in surgery.
Longer wait times persist, with only 50% of patients receiving knee replacements within the recommended 6 months
Throughout the pandemic, scheduled surgeries such as joint replacements and cataract surgeries have been the most likely to be delayed or cancelled, and many Canadians have had to wait longer to receive these surgeries.
Among adults age 18 and older, between April 2020 and September 2022 about 35,850 (20%) fewer knee replacements and 12,000 (11%) fewer hip replacements were done compared with before the pandemic. During this same period, 92,200 (10%) fewer Canadians received their cataract surgeries. Need continues to grow for these procedures due to factors such as population aging, improved joint technology and advancing surgical techniques, such that comparing pre-pandemic and pandemic levels may underestimate some of the results.
The most recent data shows that while the monthly number of scheduled surgeries is nearing pre-pandemic levels, this is insufficient to clear the backlog and improve wait times. It also shows that catching up has been more challenging for joint replacement surgeries, which are primarily performed in hospital operating rooms, than for cataract surgeries, which can be done in day procedure rooms or community clinics.
Between April and September 2022, the number of Canadians receiving knee replacements rebounded to close to pre-pandemic numbers; however, about 50% of patients waited longer than the recommended 6 months (182 days) for their surgery. These longer wait times are seen across most provinces, as health systems were catching up again from cancellations and delays that occurred during the Delta and Omicron waves. Similarly for hip replacements, only 57% of patients received treatment within the recommended time frame. Prior to the pandemic, about 70% of knee replacements and 75% of hip replacements were completed in the recommended 6-month period. Notably, 4 provinces (Ontario, Manitoba, Saskatchewan and Alberta) performed more joint replacements in the most recent period (April to September 2022) than in the same period in 2019.
For cataract surgery, pan-Canadian wait times returned to pre-pandemic levels by October 2020 and have remained there, with 66% of patients receiving surgery within the recommended time frame of 112 days. A closer look at the results, however, shows considerable variation across the provinces. Between April and September 2022, a higher proportion of patients received their cataract surgery within the recommended time frame in P.E.I., Manitoba, Alberta and B.C. compared with before the pandemic. The opposite was true in Newfoundland and Labrador, Quebec and Ontario, where a lower proportion of patients received surgery within the recommended time frame compared with before the pandemic.
Latest data shows longer wait times for cancer surgeries in 2022
Ongoing health system efforts to prioritize care have buffered the impact of the pandemic for more urgent procedures like cancer surgeries, resulting in smaller decreases in the number of procedures and smaller changes to wait times.
However, the most recent data indicates that wait times for cancer surgeries increased slightly in 2022. Between April and September 2022, half of patients waited about 1 to 3 days longer for their breast, bladder, colorectal and lung cancer surgery compared with before the pandemic, and the median wait time increased by about 12 days for prostate cancer. Although these findings varied somewhat across provinces, they suggest that health systems are continuing to work through the backlog of surgeries within current capacity and resource constraints.
The backlog in cancer surgeries was initially created by delays and cancellations primarily in the first several months of the pandemic, when about 20% fewer procedures were performed compared with before the pandemic. During this time, there were also fewer new cancer cases diagnosed than expected due to drops in cancer screening and reduced access to primary care. Analysis published by the Canadian Partnership Against Cancer shows that there were about 6% fewer new cancer cases in 2020 compared with the average from 2015 to 2019; in April 2020 alone there were about 50% fewer new prostate cancer cases, 43% fewer new colorectal cancer cases, 31% fewer new breast cancer cases and 30% fewer new lung cancer cases.
Cancer surgery volumes have been holding steady since the initial 6-month period of the pandemic. However, they have not consistently reached or surpassed the pre-pandemic volumes of surgeries needed to reduce the backlog. Between April and September 2022, the number of breast, bladder, colorectal, lung and prostate cancer surgeries performed was about 1,000 (2%) fewer than in the same period in 2019. The expected surge in cancer diagnoses combined with ongoing staffing shortages across a number of groups of health care professionals, including specialized nurses and technicians, will likely affect the ability of health systems to ramp up surgeries. Continued monitoring will be critical to assess the impact of strategies and planning efforts that are being implemented to address these challenges.
For the most recent data on wait times for cancer surgery, diagnostic imaging and other procedures, visit CIHI’s Wait Times web tool.