19-month pandemic-related surgical backlog in Ontario

Ontario, Canada, has an 84-week backlog of nonurgent surgeries delayed because of COVID-19 that will take 717 surgeries, 719 operating room hours, 265 hospital ward beds, and 9 intensive care unit (ICU) beds per week to clear, according to a time series modeling study published today in CMAJ.

Researchers at the government agency Ontario Health identified the 19-month logjam after analyzing administrative data on historical surgical volumes and operating room productivity by surgery type and region and lengths of general-ward and ICU stays from Jan 1, 2017, to Jun 13, 2020. They also developed a deterministic, Microsoft Excel–based tool to help other regions plan to address their surgical backlogs.

Tackling backlog while maintaining surge capacity

From Mar 15 to Jun 13, 2020, 148,364 nonurgent surgeries were delayed, a weekly increase of, on average, 11,413 procedures. Backlog sizes according to surgical type varied substantially across provincial regions.

The deferments came after Ontario's Ministry of Health ordered facilities to delay elective surgeries and other nonurgent clinical activity to prepare for a surge of COVID-19 patients on Mar 15. The directive was lifted on May 26, gradually allowing elective surgeries to resume.

Ontario Health recommends that hospitals ensure that they can reserve at least 10% of acute bed capacity within 48 hours and have at least 15 days of personal protective equipment (PPE) on site, backed up with a 30-day regional or subregional PPE supply, in case of a surge of COVID-19 cases.

In contrast, the backlog of urgent surgeries will take roughly 14 weeks (more than 3 months) to clear, assuming that all resources previously dedicated to COVID-19 surge capacities are used only for time-sensitive procedures.

Compared with 2019, there were 38% fewer cancer surgeries, 42% fewer cardiac procedures, 73% fewer vascular surgeries, 81% fewer transplant surgeries, 94% fewer pediatric procedures, and 96% fewer other adult surgeries in April 2020.

New strategies, dedicated resources needed

The authors noted that clearance times are only very rough estimates and will depend on the length of patient surgical recoveries and whether facilities choose to focus surge resources solely on nonurgent surgical activity. "Without any increases in resources to support surge activity, incoming new cases will lead to a subsequent backlog," they wrote.

They added that clearing the backlog will take planning and new approaches to providing surgical care to many people in a short period.

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

Previous studies have estimated large nonurgent surgical backlogs in facilities around the world, with one modeling study suggesting that it could take 7 to 16 months to clear the more than 1 million delayed orthopedic surgeries in the United States.

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