Unnecessary surgeries costing $180 million

Canadians have had thousands of potentially unnecessary surgical treatments in 2008, researchers say in a national report that suggests the health care patients receive is not always the most appropriate or cost-efficient option.

The nation could save up to $180 million if physicians considered alternative options for their patients who receive certain treatments, from caesarean section deliveries to surgeries for knee pain, an annual Health Care in Canada study released Thursday by the Canadian Institute for Health Information (CIHI) said.

"Every penny in the system concerns me. People in the health-care system, patients and taxpayers want an efficient system that is effective and provides quality and safe care to everyone. Based on the clinical evidence and studies done, there are minimal benefits associated with some surgeries," said John Wright, CIHI president and chief executive officer.

The report examined data on select surgical treatments from 2008-09.

Caesarean section deliveries and hysterectomies are the most common surgical procedures women receive, but with varying rates for these treatments from province to province, Wright said some of these procedures aren’t needed. Rates ranged from a high of 23 per cent c-section deliveries in Newfoundland to a low of 14 per cent in Manitoba. Rates of hysterectomies varied by more than 60 per cent between the provinces.

"The wide variation in surgical rates from region to region cannot simply be explained by differences in women’s health. When we see these kinds of variations, it is a cue to start asking questions about whether the care being provided is appropriate," said Jeremy Veillard, CIHI’s vice-president of research and analysis.

C-section deliveries cost hospitals nearly $5,000, approximately $2,265 more than vaginal births, the report showed.

The total cost of c-sections was estimated to be $292 million, but if the country matched Manitoba’s 14 per cent c-section deliveries, there would be 16,200 fewer surgeries and more than $36 million would be saved. About $97 million would be saved if c-section rates dipped to five per cent, a low the World Health Organization recommended in 1985.

Hysterectomy expenses hit $192 million for the "overuse" of the surgery, the report said. If rates were lowered to match B.C.’s 311 operations per 100,000 women, another $19 million would be saved.

Costs for treating patients hospitalized for heart attacks would also decrease by 22 per cent – or $125 million – if national heart attack rates dropped to match British Columbia’s average of 169 incidents per 100,000 people. The national rate is 216 per 100,000.

B.C. residents had the lowest rates of coronary heart disease because they had better lifestyles that included smoking less, working out more and eating healthier, according to the report.

Improving our understanding of the factors that influence cardiac health would lessen heart attack incidents, Wright said.

Canadians had 3,600 knee surgeries to treat pain in 2008, which cost $4 million, but studies showed the procedure does little to reduce discomfort, with many patients signing up for knee replacements within the following year.

"We don’t know in every circumstance why (these surgeries are) being done. Sometimes it reflects the education or background of the physician. It can reflect the experience of the surgeon or patient preferences and recognizing pre-existing conditions," Wright said.

The report does not investigate alternative options and the costs attached to them, but Wright anticipates his team’s findings will force physicians to think about different approaches when treating patients.

Patients waiting for arrangements in long-term care facilities were also a financial burden because hospital care is "far more" expensive compared to nursing homes, Wright said.

In 2008, these patients made up five per cent of all hospitalizations and on average, they occupied 7,550 hospital beds every day.

Nursing homes would provide better care for these elderly patients, Wright said, and their beds could be filled with waiting emergency department patients.