• CMAJ · Nov 2020

    Clearing the surgical backlog caused by COVID-19 in Ontario: a time series modelling study.

    • Jonathan Wang, Saba Vahid, Maria Eberg, Shannon Milroy, John Milkovich, Frances C Wright, Amber Hunter, Ryan Kalladeen, Claudia Zanchetta, Harindra C Wijeysundera, and Jonathan Irish.
    • Ontario Health (Cancer Care Ontario) (Wang, Vahid, Eberg, Milroy, Milkovich, Wright, Hunter, Zanchetta, Irish); Division of General Surgery (Wright), Sunnybrook Health Sciences Centre; Trillium Gift of Life Network (Kalladeen); Schulich Heart Centre (Wijeysundera), Sunnybrook Health Sciences Centre; Division of Cardiology (Wijeysundera), Department of Medicine and Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology (Irish), Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Ont.
    • CMAJ. 2020 Nov 2; 192 (44): E1347-E1356.

    BackgroundTo mitigate the effects of coronavirus disease 2019 (COVID-19), jurisdictions worldwide ramped down nonemergent surgeries, creating a global surgical backlog. We sought to estimate the size of the nonemergent surgical backlog during COVID-19 in Ontario, Canada, and the time and resources required to clear the backlog.MethodsWe used 6 Ontario or Canadian population administrative sources to obtain data covering part or all of the period between Jan. 1, 2017, and June 13, 2020, on historical volumes and operating room throughput distributions by surgery type and region, and lengths of stay in ward and intensive care unit (ICU) beds. We used time series forecasting, queuing models and probabilistic sensitivity analysis to estimate the size of the backlog and clearance time for a +10% (+1 day per week at 50% capacity) surge scenario.ResultsBetween Mar. 15 and June 13, 2020, the estimated backlog in Ontario was 148 364 surgeries (95% prediction interval 124 508-174 589), an average weekly increase of 11 413 surgeries. Estimated backlog clearance time is 84 weeks (95% confidence interval [CI] 46-145), with an estimated weekly throughput of 717 patients (95% CI 326-1367) requiring 719 operating room hours (95% CI 431-1038), 265 ward beds (95% CI 87-678) and 9 ICU beds (95% CI 4-20) per week.InterpretationThe magnitude of the surgical backlog from COVID-19 raises serious implications for the recovery phase in Ontario. Our framework for modelling surgical backlog recovery can be adapted to other jurisdictions, using local data to assist with planning.© 2020 Joule Inc. or its licensors.

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