Hamilton-Niagara hospitals need time to clear backlog of non-essential surgeries

The majority of hospitals and clinics in the Hamilton and Niagara regions that specialize in elective surgeries and clinical procedures have returned to some semblance of normalcy in June amid the COVID-19 pandemic.

In mid to late March, regional hospitals put a hold on non-essential surgical procedures to make room for a potential influx of COVID-19 patients in addition to limiting the spread of the virus by reducing traffic at facilities.

As the province moves through Stage 2 of its coronavirus recovery plan, clinical activity in a number of southern Ontario hospitals is resuming at a slow pace compared to pre-pandemic rates, according to three regional health-care providers.

“On June 8, Joseph Brant Hospital began gradually resuming surgeries and diagnostic imaging services on a non-urgent basis,” Eric Vandewall President and CEO of Joseph Brant told Global News. “Since then, we have been prioritizing patients with the most critical and urgent health needs.”

Vandewall says 386 surgeries have been completed since the Burlington hospital came back online in early June ranging from orthopedic, ear, nose and throat (ENT) procedures and some cataract surgeries.

The hospital expects to return to about 70 per cent pre-COVID activity in the first week of July, but Vandewall says it’s hard to say how many procedures have been postponed and when the facility will be caught up on surgeries that were missed.

“Like other regional hospitals that paused services in March, the rescheduling of surgeries and procedures will take some time,” said Vandewall.

Dr. Anthony Adili, chief of surgery at St Joseph’s Healthcare hospital, says it’s the same in Hamilton and that the backlogs are “challenging.”

“We have a whole host of other variables that we didn’t have to consider before, like physical distancing and how that affects our flow and all that kind of stuff,” said Adili.

“We’re working very hard trying to think outside the box of how we could increase our capacity and do things maybe different than we did before to see if we can chip away at the backlog and try to catch ourselves back up.”

In May, a study completed by a number of physicians with the COVIDSurg Collaborative network study estimated that over 28 million surgeries worldwide would be affected by the pandemic and that close to 400,000 surgeries in Canada would be cancelled.

Dr. Janet Martin, an associate professor at Western University who works with the collaborative, says even if regional hospitals step up surgical capacity it could still take close to two years on average for the country’s health-care providers to catch up.

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“We found that even if we could increase our capacity by 20 per cent in terms of surgical throughput compared to our pre-COVID numbers, that it would take 90 weeks,” Martin said.

In a separate study, the collaborative also identified a mortality risk for those having surgery in the midst of the pandemic. Research from 24 countries of over 1,100 people who either had COVID-19 at the time of surgery, or caught it 30 days after having one, had a 24 per cent chance of dying from complications.

“So that means almost one in four patients who underwent surgery with COVID diagnosed shortly before surgery, or within the month postoperatively, died within’ 30 days of surgery,” said Martin. “And those numbers are far greater than what we would expect for a comparable population in the pre-COVID period.”

In a release, Niagara Health says its clinical activity has been operating between 25-35 per cent of normal volumes since it restarted elective procedures in late May.

“Between May 25 and June 12, Niagara Health has performed 560 surgeries, including cataract, orthopedic, vascular, and gynecological procedures,” the health unit said in a release.

Hospitals in the Niagara region postponed over 3,000 procedures due to COVID-19. However, over 2,000 radiation and chemotherapy treatments continued during the pandemic.

Sharon Murphy is one of the lucky patients that finally went through a crucial knee replacement surgery at St. Joe’s in Hamilton after a three-month delay due to COVID-19.

“When I got the cancellation, … I was distraught,” Murphy said. “I was physically and emotionally ready for the surgery.”

The 57-year-old is now getting used to her revitalize knee and said that the experience in hospital was a bit lonely but safe since visitors were not allowed at the time her surgery took place.

“There were no visitors in the building, it was specifically staff and patients,” said Murphy. “You’re provided with protective gear as soon as you walk in, they take your temperature, and then you’re sent over to surgery.”

Patients that aren’t on the priority list at St. Joseph’s can expect a long wait, according to Dr. Adili.

“Elective stuff like bariatric surgery, joint replacement surgery, ear, nose and throat surgery, plastic surgery, all the stuff that we had huge volumes of that have a significant impact on people’s quality of life, those are the ones that we’re going to have backlogs.”

All three hospitals across the region are also required by the province to maintain a 10 per cent bed capacity, set aside in case of a surge in COVID-19 cases, which Adili says takes up resources needed to tackle the current backlog.

“So that affects how much bed and resources we have available in the hospital,” said Adili. “And even staffing, for example, nursing, anesthesia and surgeons. It’s a finite pool.”

The surgeon said there’s “no short answer” to when St. Joe’s will catch up with its mounting cases.

“I think it’s going to be very difficult to prognosticate exactly when we could get this backlog caught up,” Adili said. “I’m going to hazard a guess, 12-plus months, at least.”