This article was written by the Canadian Institute for Health Information. Published May 10, 2022. To access the original article,click here.
How long did Canadians wait for surgery, diagnostic imaging and other procedures during the first 18 months of the COVID-19 pandemic? How did the wait times and the number of procedures compare with the pre-pandemic picture? Keep reading to learn how wait times for priority procedures — knee replacements, hip replacements, hip fracture repairs, radiation therapy, cataract and cancer surgeries, and diagnostic imaging — were impacted between April 2020 and September 2021. While this data largely predates the Delta, Omicron and BA.2 waves, key findings will inform system recovery and planning efforts moving forward.
- This analysis looks at 18 months of data from the pandemic period in 6-month increments (April 2020 to September 2021).
- For this analysis, the term “wave” refers to significant surges of community cases of COVID-19 infections in Canada overall, although we recognize that the timing and size of the waves may vary by jurisdiction.
COVID-19 restrictions in hospitals led to a backlog of procedures
Scheduled surgeries and other medical procedures were delayed several times as Canada’s health systems prioritized more-urgent treatments during COVID-19 waves. Delays varied by urgency of the surgery and clinical setting, as well as by jurisdiction.
Overall, joint replacements and cataract surgeries accounted for nearly one-quarter of the total reduction in surgeries, and decreases in these surgeries were greatest at the start of the pandemic. Detailed information on decreases in surgical volumes during the COVID-19 pandemic is available upon request.
During the pandemic, orthopedic surgical beds on our short stay unit were occupied by COVID patients. To increase our capacity to provide hip and knee replacements, we expanded our day surgery program in Central Zone, completing over 700 outpatient hip and knee replacements in 2021–2022 compared with less than 100 in 2019–2020. Additional supports were put in place to help, specifically nursing and rehabilitative services to facilitate discharge home on the day of surgery. Discussions on further strategies to address wait time delays made worse by the pandemic are ongoing.—Lynn Molloy, Manager of Surgical Wait Lists, Nova Scotia Health
Longer wait times continued for joint replacements, while cataract surgery wait times returned to pre-pandemic levels in most provinces
Between October 2020 and September 2021, patients receiving hip and knee replacements continued to experience longer wait times, while cataract surgery wait times returned to pre-pandemic levels in most provinces. During this period, volumes for these scheduled surgeries fluctuated — at times, they rebounded to pre-pandemic levels or slightly higher. Wait times for all 3 of these procedures improved compared with the first 6 months of the pandemic (April to September 2020), during which time only half of patients were treated within recommended time frames and volumes were down by over 40%.
- For joint replacements, about 62% of patients across Canada were treated within the recommended time frame (182 days) between October 2020 and September 2021, compared with 71% in the pre-pandemic period. A lower or similar proportion of patients receiving care within benchmark was noted in all provinces except Prince Edward Island, where wait times improved for knee replacement.
- For cataract surgery, 66% of patients across Canada were treated within the recommended time frame (112 days) between October 2020 and September 2021, compared with 70% in the pre-pandemic period. For 7 of 10 provinces, the wait times were shorter or similar to those in the pre-pandemic period; however, the proportion of patients in Ontario, Quebec and Newfoundland and Labrador who were treated within benchmark remained 6% to 10% lower than in the pre-pandemic period.
Figure 1 Percentage of Canadians treated within benchmark time frames for joint replacements and cataract surgery, April 2019 to September 2021
Benchmark wait times are 182 days for hip and knee replacements and 112 days for cataract surgery.
Wait time data excludes the territories.
See full national and provincial data on wait times and volumes.
More-urgent procedures like hip fracture repair, radiation therapy and cancer surgery were prioritized
Throughout the pandemic, when surgeries have been delayed due to COVID-19 waves, health systems have prioritized the continuation of more-urgent procedures such as cancer surgery, radiation therapy and hip fracture repair. As a result, hip fracture repair and radiation therapy wait times and volumes have not been generally impacted by COVID-19 waves. Between April and September 2021, 85% of patients received hip fracture repair within the recommended 48 hours, while 97% of patients received radiation therapy within the recommended 4 weeks. These proportions have remained stable for at least the last 5 years, with little variation across the provinces.
Wait times for cancer surgeries were also similar to those reported in the pre-pandemic period, with changes in wait times and decreases in cancer surgeries primarily limited to the initial months of the pandemic. Overall, cancer accounted for about 3% in the reduction of surgeries during the first 18 months of the pandemic.
Between April and September 2021, cancer surgery wait times returned to those observed in the pre-pandemic period. Half of patients waited between 18 and 24 days for breast, bladder, colorectal and lung cancer surgery, while the median wait time for prostate surgery was 43 days. For this same period, cancer surgery volumes rebounded in 2021 to just under 5% of the pre-pandemic levels. This is a considerable increase from volumes reported for April to September 2020, when the number of cancer surgeries completed was about 20% less than in the pre-pandemic period.
While wait times for procedures such as cancer surgery and joint replacements paint an important picture of the impact of COVID-19 on health care systems, this data does not tell the full story from both a patient and health system perspective. Pandemic-related delays in access to preventive care, specialist consultations and pre-surgical testing and imaging are expected to add to the backlog of surgeries created by efforts to mitigate the impact of COVID-19 waves.
Figure 2 Median wait times for cancer surgery in Canada, by surgery type, April 2019 to September 2021
Median refers to the number of days that half of all patients waited before receiving care.
Wait time data excludes the territories. Manitoba data is not available for bladder, colorectal and prostate cancer wait times.
After the first wave, wait times for MRI scans were shorter than before the pandemic, while wait times for CT scans remained the same
Wait times and volumes for diagnostic imaging provide further evidence of health system efforts to recover and maintain quality health care for Canadians. Between October 2020 and September 2021, at a national level, median wait times for MRI scans were shorter by 4 to 5 days compared with the pre-pandemic period, while waits for CT scans remained the same.
Changes in wait times for diagnostic imaging generally corresponded with increases in the number of scans completed. During the 6-month period October 2020 to March 2021, the number of diagnostic imaging scans surged well above pre-pandemic levels (9% higher for CT and 8% higher for MRI). This is in contrast to the April to September 2020 period when volumes of diagnostic imaging scans dropped by over 20%. Volumes were similar to pre-pandemic levels between April and September 2021.
Wait times for diagnostic imaging, as well as changes in these wait times during the pandemic period, varied considerably among the provinces. Between April and September 2021, median wait times for MRI scans were 6 to 27 days shorter compared with pre-pandemic wait times in Prince Edward Island, Ontario, Saskatchewan and Alberta (Figure 3), whereas they were similar to pre-pandemic wait times in British Columbia, and 11 and 30 days longer in Manitoba and Nova Scotia, respectively.
Figure 3 Median wait times for CT and MRI scans in Canada, April 2019 to September 2021