Access to surgery relates to the waiting time for a surgical procedure. Common surgeries include hip and knee replacement, cancer surgeries, and more. The official wait time begins when a citizen and their surgeon determine that a surgery is needed, and a citizen is ready to receive it.
For surgeries like hip, knee and cataract surgery, there are associated national benchmarks used to measure if surgeries are being performed within a medically accepted recommended timeframe. For example, the national benchmark for a knee replacement surgery is 6 months or 182 days. This means that the wait time between readiness for surgery and the actual procedure date should not exceed 182 days.
The NBHC created a data table that includes indicators related to surgical wait times. The data is available at the provincial, Regional Health Authorities and zone levels and will be updated quarterly as information from the Surgical Access Registry data becomes available.
The following key observations on Access to Surgery are based on the Surgical Access Registry data from January 1st to March 31st, 2023.
Reported wait times for surgeries only capture part of a citizen’s journey to receiving the health care they need
The surgical wait time only measures a small portion of the journey that citizens undertake until their surgery can be performed. Typically, this journey starts with the onset of symptoms and involves different waiting periods :
1. Waiting period to see their primary care provider: This waiting period represents the time between the onset of symptoms and the day a citizen sees their primary care provider.
2. Waiting period for the referral: This waiting period represents the time between the visit to the primary care provider and the acceptance of the referral by the specialist. It’s important to note that, not all New Brunswickers are attached to a primary care provider. These individuals may experience further delays to receiving a referral to a specialist.
3. Waiting period to see a specialist: This waiting period represents the time between the receipt and acceptance of the referral by the specialist and the day that the citizen is seen by this specialist.
4. Waiting period for surgery: This waiting period is currently measured by the health care system. Once the citizen and their surgeon determine that a surgery is needed, this wait time represents the period between the day that a citizen is deemed ready for surgery and the day that the surgery is performed.
Wait times for surgeries vary depending on where the surgery is being performed
During the pandemic, surgeries (particularly hip and knee replacement) experienced delays across Canada, resulting in a lower percentage of surgeries being performed within their recommended benchmark. This situation was also observed in New Brunswick. Based on the most recent data (Jan – March 2023), 34% of hip replacement surgeries and 26% of knee replacement surgeries were completed within the national benchmarks of 182 days (6 months).
The median wait time for completing a surgery has also been getting worse over time.
Within New Brunswick, the waiting period for the same surgery can vary from one region to another, depending on where it is scheduled to be performed.
The graph below can be used to compare the different surgery wait times for New Brunswick as well as the seven health zones.
Several factors may influence surgical wait times:
1. The surgeon that the primary care provider referred the citizen to. Some surgeons have longer waiting lists or perform fewer surgeries within a given period.
2. The priority level of the surgery. The priority level is determined by a specialist’s assessment of the citizen’s medical status.
3. The capacity of the hospital. This includes the availability of staff and operating rooms to accommodate the procedure, as well as availability of beds to accommodate the patient after the surgery.
A new tool gives access to wait times by surgeon and procedure
Before being referred to a specialist, a citizen and their primary care provider can access the Government of New Brunswick portal on surgical wait times, by clicking on the “surgeon” tab. This portal enables citizens and primary care providers to see each surgeon’s wait times by procedure. Based on that information, citizens and their primary care providers can discuss their referral options and make choices that better reflect their health care needs.
How will an increase in the number of completed orthopedic surgeries impact wait times?
Knee and hip replacement surgeries (orthopedic surgeries) are a key focus of the New Brunswick government Provincial Health Plan. Since April 2022, there has been an increase in the number of hip and knee replacement surgeries completed. This increase is starting to translate into a decrease in the number of orthopedic surgeries waiting to be performed.
The primary focus has been on addressing long waiting surgeries (surgeries that have been waiting longer than a year to be completed), leading to a reduction in these numbers across all zones. As the volumes of surgeries being performed increase and the surgeries waiting to be performed decrease, it is expected that the system will gradually reduce the median wait times, provided the capacity continues to meet the growing number of citizens who may require a surgery in the future.
In New Brunswick, and across most provinces in Canada, there is little information available regarding the first three waiting periods in the journey for surgery. Benchmarks, when they are available, are good indicators to compare performance and track trends over time. However, they only provide insight about the last waiting period, without giving the full picture about the patient’s experience.
Citizens are experiencing waiting periods for access to surgery that exceed the timeframes reported to the public. By better understanding the waiting periods and the different factors involved, citizens and their primary care provider would be better equipped to make informed decisions that can lead to improved timely access to surgeries for New Brunswickers who need them.
As the province meets the identified target to eliminate the number of hip and knee surgeries that have been waiting longer than a year by March 2024, efforts need to shift towards the nationally recommended benchmark of 182 days, or 6 months.