Study shows unprecedented impact of COVID-19 on surgical care in Ontario

The estimated time to clear surgeries postponed in Ontario because of the coronavirus disease 2019 (COVID-19) pandemic is 84 weeks, with a target of 717 surgeries per week, according to a new modelling study in CMAJ (Canadian Medical Association Journal).

The magnitude of the surgical backlog from COVID-19 raises important implications for planning for the recovery phase and for possible second waves of the pandemic in Ontario."

Dr. Jonathan Irish, Surgeon at Princess Margaret Cancer Centre/University Health Network and the University of Toronto, Toronto, Ontario, with coauthors

In mid-March, the Ontario Ministry of Health directed Ontario hospitals to cancel elective surgeries and other non-emergency-related activities to help prepare for an anticipated surge in patients with COVID-19. On May 26, the directive was lifted, allowing hospitals to begin ramping up elective and time-sensitive surgeries.

In April 2020, there were 38% fewer cancer surgeries, 42% fewer cardiac surgeries, 94% fewer pediatric surgeries and 96% fewer miscellaneous adult surgeries compared with the previous April. Between March 15 and June 13, there was a backlog of 148 364 surgeries. It will take 84 weeks - more than 1 ½ years - to complete these surgeries, with an estimated 14 weeks for time-sensitive surgeries (mainly cardiac, vascular and cancer surgeries) if resources are focused specifically on these procedures.

"This work shows the unprecedented magnitude of the secondary impact of COVID-19 on surgical care in Ontario," the authors write.

The modelling approach may be used in other provinces and territories to help with recovery planning.

"To effectively manage this impact on more than 140 000 patients, health systems and surgical leaders cannot get back to business as usual, but rather must employ innovative system-based solutions to provide patients with timely surgical care and prepare for future COVID-19 waves," the authors conclude.

An estimated 7600 pediatric surgeries were postponed between mid-March and June, and an additional 4000 children's surgeries could not be scheduled because of reduced access for surgical consultations, according to a related commentary.

"As Canada moves into a pandemic recovery phase, there is a danger than adult patients will be favoured by efforts to address the impact of disrupted access to surgery and to reduce the backlog of surgery," cautions Dr. Erik Skarsgard, a surgeon at the British Columbia Children's Hospital, Vancouver, BC, and member of the Pediatric Surgical Chiefs of Canada group. "Children are not small adults and they are not less deserving. Children have unique surgical needs that require prioritization within our health systems."