Alberta’s operation waitlist a ‘hidden pandemic,’ doctor says

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Cheryl Sword can feel them, the cysts on her ovaries. The two lumps are 12 centimetres in diameter and growing. The one on her left ovary feels larger than its counterpart on the right.

“It feels like a Jello-y grapefuit,” said Ms. Sword, a 35-year-old Alberta resident with Crohn’s disease and a family history of cancer.

The cysts need to be removed, but Ms. Sword said her consultation appointment with a surgeon was indefinitely postponed last March because of the coronavirus. Alberta has postponed 4,300 scheduled elective operations since November, but this tally does not reflect the true scale of the backlog. Ms. Sword’s pending procedure, for example, is not counted among the delayed because it had not yet been scheduled. Further, the nature of the waiting list is also changing, with more complicated procedures piling up.

Michael Châtenay, a general surgeon at Grey Nuns Community Hospital in Edmonton, said while Alberta Health Services’ count of delayed operations is worrisome, the greater risk is unknown: how many people need surgery but are unable to see a specialist because of the pandemic.

“This really is the hidden pandemic,” he said. “We have no idea how many people like that there are out there.”

Alberta slowed the pace of surgery in Edmonton by about 30 per cent in November to have enough beds, staff and equipment for the rush of patients needing critical care for COVID-19. Last month, as infection rates exploded, the province said it may postpone up to 60 per cent of elective operations in Edmonton. Delays in Calgary followed.

Kerry Williamson, a spokesman for Alberta Health Services, said most of the 4,300 non-urgent operations that have been deferred since November were in Edmonton, but the percentage has not yet reached 60 in that city. Operating rooms in the Edmonton zone are currently running at 83 per cent of 2019′s activity, while those in Calgary are at 85 per cent, he said.

Alberta has increased the number of procedures that do not require hospital stays, such as cataract surgery, in an effort to keep operating rooms running during the COVID-19 spike. While this has helped offset the number of postponements, it means the waiting list is now composed of more difficult operations, Dr. Châtenay noted. This will affect how quickly surgeons can clear the backlog.

“It will be complicated work,” he said. (AHS did not provide information on the types of operations dominating deferrals. The provincial health ministry did not provide comment on the backlog and its plans to address it.)

Alberta’s operating suites do not run 24 hours a day, and activity slows over holidays and the summer. The province could increase daily operating hours to ease the backlog when the time comes. However, to do that, it will need to pay for surgeons and nursing staff, Dr. Châtenay said. Alberta is already short on anesthesiologists, he added.

Meanwhile, Manitoba said on Friday that it will “carefully” begin to increase surgical activity this week, because hospital admissions are stabilizing. It will focus on orthopedic and retinal procedures, as well as vascular, renal, ear, nose and throat, and other general surgery that cannot be put off any more, the province said in a statement.

“We must begin to carefully increase access to surgery to meet the needs of patients whose procedures can no longer be delayed,” said Lanette Siragusa, chief nursing officer for Shared Health. “This will be a slow and gradual increase while we continue to monitor COVID-19 activity and the staffing demands that remain across medicine and critical care.”

Manitoba in early December stopped reporting the number of delayed procedures because the figures did not reflect the magnitude of the problem. At the time, it had postponed about 2,300 elective adult operations.

Before Christmas, Saskatchewan Health Authority reduced operations in Saskatoon and Regina by 35 per cent, save for third-party surgical providers. All elective surgery in North Battleford and Prince Albert was also put on hold.

In Alberta, Cynthia Wandler’s father is among those whose surgery is in limbo. Her dad has hydrocephalus, and his brain has a significant fluid buildup, Ms. Wandler said. On Dec. 3, his neurosurgeon at the Kaye Edmonton Clinic confirmed that the 68-year-old needed surgery, but does not know when it will happen. The family has gone public with the situation in hopes it will help others understand the sweeping consequences of widespread COVID-19.

“People need to hear more of these stories, about the vast and immeasurable consequences of their individual choices,” Ms. Wandler said. “It’s not as though death [from the infection] is the only thing to be concerned about with COVID.”

Alberta, like other jurisdictions that have pulled back on surgery, still performs all urgent and emergency operations. However, Ms. Wandler says the public may not realize this still leaves thousands of people in precarious situations.

“Elective surgeries can still be very, very critical surgeries,” she said.

Meanwhile, Cheryl Sword recognizes that the prospective operation to remove the cysts on her ovaries is not as urgent as others, but worries that she and those like her will get lost in the mix as the health care system focuses on high-priority procedures and COVID-19.

“I wonder if I’ve fallen through the cracks,” Ms. Sword said.

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