Vancouver Island patients are facing some of the longest wait times for joint-replacement surgeries in the country, a new report from the Canadian Institute for Health Information says.
Only 45 per cent of patients got hip-replacement surgery and 29 per cent got knee-replacement surgery within the recommended 26-week period.
Nationally, 79 per cent of patients got hip-replacement surgery and 73 per cent got knee-replacement surgery over the same period.
James Bay resident Elizabeth Kozak, 70, said she faced more than $20,000 in expenses when she went to Quebec for hip-replacement surgery, after being told she would have to wait a year in Victoria.
She was diagnosed with osteoarthritis in her 40s, but her right hip deteriorated significantly a year and a half ago.
After a life of exercise and healthy eating, the prospect of being more sedentary and on pain killers while she waited was not worth it, she said.
“It was a 40-minute operation, for me to be able to have my life back,” Kozak said. “And of course, what happens is you deteriorate over the year or two you wait. They say it’s better if you go as young as you can and in good shape, if you need it. So here we are costing the system more, because you end up with other difficulties because of the wait time.”
While the retired school superintendent could afford the cost, she said she hoped wait times would shorten for others, who could not.
Across the province, average wait times are increasing for many surgeries at the same time that more surgeries are being scheduled — with a growing and aging population being a possible explanation.
For hip replacements, 61 per cent of British Columbians met the benchmark wait time in 2016, down from 80 per cent in 2012. Knee-replacement patients dropped to 47 per cent from 74 per cent. For cataract surgery, 66 per cent of patients met the benchmark, compared with 85 per cent in 2012.
On the bright side, 86 per cent of patients had hip fractures treated within 48 hours in 2016, compared with 81 per cent in 2012. And almost all patients — 91 per cent — received radiation therapy within four weeks of being ready for treatment.
Rebalance MD chief executive Stefan Fletcher said the clinic, which hosts all of the capital region’s orthopedic surgeons, receives an average of 1,300 to 1,400 referrals per month. There are about 3,500 patients waiting for a consultation.
Many of those patients are put on physiotherapy, weight loss and other regimes first. One quarter to one third will need surgery, he said. “It’s challenging because the reality is that these patients aren’t making up their conditions. It’s real. And we are constantly dealing with patients who are trying to accelerate themselves through the list because they are in pain,” Fletcher said. “The amount of people on the wait-list has decreased over the last three years. But in saying that, the amount of people who are having surgery continues to ramp up.”
The wait list largely comes down to resources, he said, and one big factor is competition for beds. When there’s a flu outbreak, for example, some surgeries have to be cancelled even if there’s an operating room available, because there won’t be a place for the patient to recover.
“Until we get a dedicated joint unit, a unit with protected beds for hip and knee surgeries — we’re continually going to be jumping back and forward to stay on target for the wait times.
While wait times may be long, Fletcher emphasized that care is excellent.
Island Health has found efficiencies, so that four to five surgeries can happen every day, compared with three to four a few years ago. It also has one of the quickest referral-to-consult rates in the province, he said. “We have a six- to 10-week wait to see a specialist here. In Vancouver, you have to wait 18 to 24 months,” Fletcher said.
Health Minister Terry Lake said one factor pushing wait numbers higher is a provincial initiative to reduce wait times in the long run. It helped some of the longest-waiting patients to get surgery, so while there were more surgeries, the average wait time also increased, he said. “The initiative has the ironic effect of increasing the average, but it is getting at those longest-waiting patients.”
The ministry is working to streamline surgical services, including standardizing how surgery priorities are set and using pooled referrals among surgeons instead of having patients wait for individual surgeons.
Royal Jubilee Hospital and Victoria General Hospital are among 11 early-adopter facilities trying out a new wait-list management system.
The new View Royal Surgical Centre is expected to open next to Victoria General Hospital soon and will perform between 2,500 and 2,750 day surgeries annually.
At the Cowichan District Hospital, staff found ways to improve efficiencies, including a system that allows instruments to be cleaned and put back into service faster, the ministry said.
Tracy Johnson, CIHI’s director of health system analysis and emerging issues, said the data suggests an increase in demand that B.C. is unable to meet. But the jump in wait times seems to be stabilizing, based on data from this year and last year, which suggests the province’s initiatives may be working, she said.
