Surgical waits vary a lot between Ontario hospitals: study

A new study shows “enormous” differences around Ontario in wait times for common surgeries, with the average patient at some hospitals waiting as much as 15 times longer than patients referred elsewhere for the same procedure.

The study analyzes the time patients wait, from the doctor’s decision to operate until the actual date of surgery, for five common non-emergency operations: hip and knee replacements, cataract surgery, gallbladder removal and uterine surgery. 

The authors found what they describe as “extreme variability” in those wait times, both between different hospitals and between different surgeons. They also found dramatic differences in waits among patients with the same hospital or surgeon.

Just boosting the overall availability of surgeries may not help Ontario bring down the extremely long waits unless the province better co-ordinates its wait-list system, the authors say.

“Each patient is part of a disconnected queue linked to a single surgeon,” the authors write in the peer-reviewed study, published in PLoS ONE, an online scientific journal. 

“Increasing the supply of surgical services will not necessarily reduce the longest wait times without a co-ordinated system that better matches demand to supply.”

Dr. David Urbach, the study’s lead author and head of the department of surgery at Women’s College Hospital in Toronto, says the findings show that patients with a similar level of need for the same surgery are waiting vastly different amounts of time.

“The problem isn’t that everybody’s waiting too long overall, but that some people, for whatever reason, are just waiting too long,” said Urbach in an interview.

“Those people are suffering more than they have to, and we have to figure out a way to be able to get care to those people more quickly.” 

The study is based on data from some 940,000 surgeries performed at more than 100 hospitals during a six-year period before the COVID-19 pandemic. All of the patients had been assessed as having the same level of need for their surgery, what Ontario categorizes as “priority level 4.”

One data point the study examines for each procedure is the median wait time. In other words, the wait experienced by the “middle” patient of each hospital or surgeon, with half of patients waiting longer and half waiting less.

The authors describe the variations in median wait times between hospitals as striking. For instance, there’s a 15-fold difference in the median wait time for knee replacement between the hospitals with the shortest and longest waits.

The differences between surgeons are even more stark, the paper says.

The median wait time among the more than 1,800 surgeons included in the study ranged from 15 to 249 days for cataract surgery, and from 16 to 382 days for hip replacement.

Adding more surgical capacity isn’t enough: author

While the paper doesn’t attempt to figure out all the reasons for the wide variation in wait times, previous research on the same data found the differences cannot be explained by patient demographics.

Urbach says simply adding more surgical resources won’t on its own reduce the enormous variations in wait time, because under Ontario’s existing system of multiple waitlists, there’s no way to ensure that the extra resources are directed specifically to the patients who are waiting the longest. 

“It is very likely that some extra resources may be needed in some areas, but we won’t really know that for sure until we have some way to co-ordinate care by bringing patients into a single queue,” he said.

The study recommends Ontario adopt a centralized referral system. Instead of your family doctor referring you to one particular surgeon, all referrals would go into a centralized waitlist and each patient would get assigned to the next available provider in their area.

WATCH | How a standalone clinic in Ontario is making surgeries happen faster

High-efficiency operating rooms show promise for cutting wait times

An Ontario doctor has tested his plan for streamlined surgery centres that treat more patients in less time, all in the public health system. Now, it’s a model other hospitals are hoping to duplicate.

While that switch could shorten the first wait that patients face — between the time they are referred by their family doctor and the time they see the specialist to be assessed for surgery — it doesn’t necessarily deal with the next wait, from approval for surgery until the operation happens.

Grouping surgeons in teams could help

Urbach suggests creating teams of surgeons for these common procedures, pooling their availability to reduce variability in wait times among the group.

It’s a system that already exists in Ontario for some more specialized procedures, including obesity surgery and some complex cancer surgeries.

Those surgical-team programs have proven to meet patients’ needs very well, said Urbach.

“It also helps support quality of care by standardizing how surgeons work together and making sure that everybody performs to a high level of quality, which results in a high level of patient satisfaction.”

Dr. Sean Cleary, the president of the Canadian Association of General Surgeons, who was not involved in the research, says there’s a disconnect between the demand and supply of surgery in Ontario.

“I think the vast majority of surgeons in the province of Ontario are frustrated by their ability to deliver timely care, as are their patients,” he said in an interview. 

“While this [paper] demonstrates the severity and the extent of the problem, I think we’ve known that these variabilities exist in Ontario, and in fact probably across Canada,” said Cleary, who is also chair of general surgery at the University of Toronto.

While he believes a centralized waitlist may help allocate some surgeries more efficiently, he says not all patients would be comfortable with a system that assigns them to the next available hospital or surgeon. 

Ontario Health, the provincial agency responsible for co-ordinating health services, says advancing centralized intake is a key goal of a new wait-list management program established to tackle the backlog of procedures delayed by the pandemic.

That program “is focused on implementing digital health tools and clinical operating models to enable enhanced load balancing of surgical and diagnostic imaging cases, as well as lowering patient wait times for these procedures,” said a spokesperson for Ontario Health in an email to CBC News.

Ontario posts average wait times at each hospital for certain surgeries, along with provincial averages and the percentage of patients seen within the targeted time frame. For instance, 82 per cent of priority level 4 knee replacement patients are treated within the target of six months between the decision to operate and the surgery.

Recent data show Ontario’s wait times for several common surgeries are the shortest in Canada.

Premier Doug Ford’s government plans to licence new stand-alone surgical clinics, which could be run by the private sector, to provide OHIP-covered surgeries.