COVID-Caused Surgical Back-Logs

"I have lost a lot of patients on the wait list [surgical procedure priority wait list]. Patients have died because we've had to make decisions about who is the person we have to treat first ..."

"Those patients and their families deserve recognition that they are victims of this pandemic, too."

Dr.Harindra Wijeysundera, interventional cardiologist, head, cardiac care, Sunnybrook Health Sciences Centre, Toronto

"There are groups of surgeons who are saying 'I believe we're at a tipping point where I don't believe I can ever get caught up."

"I can't get caught up [they say] because I can't possibly work every weekend. Even if they gave it to me [re-arranged, extended surgical scheduling at hospitals]."

Dr.Mohit Bhandari, president, Canadian Orthopedic Association

Since Alberta Health Services (AHS) temporarily halted elective surgeries on March 18, at least 22,000 people had procedures put on hold in 2020 alone. (Shutterstock / StockLeb)

 

This is the extent to which the pandemic of the SARS-CoV-2 virus has inflicted itself in its all-consuming presence, threat and depredations on human health and the monopolization of the health care system, that has paralyzed hospital surgeries for a vast number of people desperately awaiting their opportunity for attention to be given to their emergency, non-COVID-19 maladies that have upended their lives, assaulted their health and given them an uncertain future -- if it doesn't kill them first as a result of unattended need.

Operations have been cancelled right, left and centre with ensuing backlogs and elongated wait times in a soaring misalignment of priorities forced upon the medical community by uncertainty, trepidation and anxiety to be able to meet the impending crisis that was seen to cripple the health system and medical community's capacity to react, when Italy and the United States and Brazil became poster-nations for the doomsday scenario feared by all countries globally, all equally in the line of fire of the global pandemic.

In Ontario alone twice as many people suffering heart ailments expired while waiting for surgery throughout the pandemic days, as did those numbers pre-dating the appearance of COVID-19, swamping health care systems everywhere. Doctors dreaded the anticipation of a nightmare scenario where they would have to make life-changing, life-ending decisions in determining who among their patients presenting with serious COVID symptoms would be likelier to survive and thus would be viewed as appropriate choices for treatment; the others set aside, to allow events to unfold as they might.

As matters settled down, and newer, helpful treatments were conceived of, and fewer COVID patients died, in Ontario those life-and-death choices did not, after all, have to be made to compensate for insufficient beds amidst strained health-care. Not for COVID. In actual fact, the dreadful decision-making was shunted off to other types of situations. Triage was taking place in cardiac care, explained Dr.Wijeysundera; for over a year this is what cardiac surgeons have been struggling with.

 

A surgery takes place in this file photo. (AP Photo/Francois Mori)

 

Across the country a logjam of hundreds of thousands of surgeries grew as hospitals put off 'elective' surgeries to make space, free up doctors and nurses to focus on COVID and more beds made available for ICUs meant for the care of COVID-19 patients suffering extreme and potentially lethal symptoms of the coronavirus. Those delayed treatments spoken of as 'elective' were all too often anything but. It described patients waiting for eye procedures to allow them to retain their vision; orthopedic operations for debilitating joint pain and surgery for the removal of cancerous tumours.

Every province in Canada cancelled "elective" surgery last March for an initial three-month period, spurred on by news coming out of northern Italy and New York City, as hospitals and intensive-care units were overwhelmed by a crush of seriously ill COVID patients and health-care officials made the decision that non-emergency surgeries could be suspended in preparation for a potential flood of coronavirus emergency cases. 

 

Ontario's Financial Accountability Office figures put the province's surgical backlog at 419,000 by September, judging that it will require $1.1 billion to clear up the waiting case load, over a period of three and a half years. "Without question, we're seeing a higher severity of disease", said surgeon Dr.Michael Brandt who has witnessed a clear fallout from both surgery waits and delays in patients diagnosed with skin cancer.

Ophthalmological procedures' increased wait times could result ultimately in greater numbers of people suffering vision loss. According to a recent paper by researchers from Queen's University and University of Toronto whose modeling study looked at cancellations during the first wave, suggesting waits for orthopedic surgery such as  hip and knee replacements would increase 3.4-fold on average, where a half-year wait would become 21 months in limbo.

 

Patient prepared for operation at Cambie Surgery Centre in Vancouver, 2016. The B.C. government has contracted for surgeries in private clinics as well as adding hospital capacity to catch up on 30,000 procedures to prepare for COVID-19 cases in the medical system. (The Canadian Press)