US ad uses lure of prompt treatment to entice Canadians needing joint replacement.

A Virginia hospital has used newspaper advertisements to solicit Ontario patients who are waiting for hip- or knee-replacement surgery. The ads promote the medical services of US orthopedic surgeons and call attention to exasperatingly long waiting lists for the same surgery in Canada. "Pain doesn''t wait," they state. "Neither should you." The hospital says it has been receiving more than 100 calls a week inquiring about the procedure, which costs $15000 (US).     

Waiting for coronary revascularization in Toronto: 2 years' experience with a regional referral office.

OBJECTIVES: To determine the frequency of major adverse events among patients awaiting coronary revascularization; to assess the match between referring physicians'' estimates of urgency, a computer-generated multifactorial urgency rating score and actual waiting times; to determine the changes in waiting times as capacity for bypass surgery increased; and to evaluate the influence of choice of procedure or operator on waiting times. DESIGN: Consecutive case series. SETTING: Greater Toronto region. SUBJECTS: All 571 patients referred to an organized referral office by cardiologists at hospitals without on-site revascularization facilities between Jan. 3, 1989, and June 30, 1991. MAIN OUTCOME MEASURES: Preoperative fatal or nonfatal myocardial infarction; proportions of patients waiting longer than the maximum period recommended for their urgency rating; mean waiting times for various subgroups; and correlations among referring physicians'' urgency ratings, computer-generated multifactorial urgency scores and waiting times. RESULTS: Of the 496 patients accepted for a procedure 5 had fatal cardiac events and 3 nonfatal myocardial infarction. Events occurred three times more often in patients with left mainstem disease than in those in other anatomic categories (relative risk [RR] 3.05, 95% confidence interval [CI] 1.48 to 6.27, p = 0.03). Both the computer-generated scores and the referring physicians'' scores were correlated with the actual waiting time (r = 0.46 and 0.57 respectively). Waiting times and the proportion of patients with excessive waiting times fell during the study period (p < 0.0001). However, urgent cases were much less likely to be done "on time" than those with a recommended waiting time of more than 2 weeks (RR 0.16, 95% CI 0.11 to 0.25, p < 0.0001). The mean wait for coronary artery bypass grafting (CABG) was 22.73 days if the referral office was allowed to find a surgeon or interventional cardiologist and 35.31 days if one was requested (p = 0.002 after adjustment for urgency scores). CONCLUSIONS: Death of a patient on the waiting list is uncommon in an organized referral system. Patients with left main-stem disease are at higher risk of death than those in other anatomic categories. There were significant correlations between referring physicians'' ratings of urgency, multifactorial urgency scores and actual waiting times. Expansion of capacity for CABG led to shorter waiting times, but patients with unstable symptoms continued to wait longer than recommended. Requests for a specific surgeon caused significantly longer delays.     

The Hospital Incidence and Clinical Significance of Congenital Heart Malformations Resulting from Rubella Embryopathy

A retrospective study is reported of 75 children with rubella embryopathy syndrome, admitted to the Health Centre for Children, Vancouver General Hospital, during the four-year period from July 1, 1964 to July 1, 1968.Sixty-four of the 75 had cardiovascular malformations, 37 had ophthalmological defects, 31 had nerve deafness and three were mentally retarded. The most common cardiovascular defects were patent ductus arteriosus (36 patients), ventricular septal defect (22 patients) and pulmonary valvular stenosis (17 patients).Ninety-three per cent of the mothers had a history of exposure to rubella during their first trimester.The administration of gamma globulin to mothers exposed to rubella did not prevent fetal damage.Although this group of patients accounted for only 6% of children requiring open-heart surgery, it did account for 27% of the children having closed-heart surgical procedures and 10% of the case load of the cardiac catheterization laboratory.     

Disparities in the Burden of HIV/AIDS in Canada

Background

We aimed to characterize changes in patterns of new HIV diagnoses, HIV-related mortality, and HAART use in Canada from 1995 to 2008.

Methods

Data on new HIV diagnoses were obtained from Health Canada, HIV-related mortality statistics were obtained from Statistics Canada, and information on the number of people on HAART was obtained from the single antiretroviral distribution site in British Columbia (BC), and the Intercontinental Marketing Services Health for Ontario and Quebec. Trends of new HIV-positive tests were assessed using Spearman rank correlations and the association between the number of individuals on HAART and new HIV diagnoses were estimated using generalized estimating equations (GEE).

Results

A total of 34,502 new HIV diagnoses were observed. Rates of death in BC are higher than those in Ontario and Quebec with the rate being 2.03 versus 1.06 and 1.21 per 100,000 population, respectively. The number of HIV infected individuals on HAART increased from 5,091 in 1996 to 20,481 in 2008 in the three provinces (4 fold increase). BC was the only province with a statistically significant decrease (trend test p<0.0001) in the rate of new HIV diagnoses from 18.05 to 7.94 new diagnoses per 100,000 population. Our analysis showed that for each 10% increment in HAART coverage the rate of new HIV diagnoses decreased by 8% (95% CI: 2.4%, 13.3%)

Interpretation

Except for British Columbia, the number of new HIV diagnoses per year has remained relatively stable across Canada over the study period. The decline in the rate of new HIV diagnoses per year may be in part attributed to the greater expansion of HAART coverage in this province.     

Haemodynamic effects of buprenorphine after heart surgery.

The effect of buprenorphine on the cardiovascular system was examined in 11 patients during the period of reduced cardiac reserve after open-heart surgery. Within 10 minutes of giving the full analgesic dose (5 microgram/kg) intravenously the mean heart rate had fallen significantly by six beats/min. Although in two patients the mean arterial pressure fell by 24 mm Hg, there was no overall change in mean arterial pressure, cardiac output, or peripheral resistance. In a further six patients buprenorphine was used successfully as the sole analgesic after open-heart surgery. Buprenorphine appears to be safer than morphine for use in patients with reduced cardiac reserve and is of similar analgesic efficacy.     

Urine and Serum MicroRNA-1 as Novel Biomarkers for Myocardial Injury in Open-Heart Surgeries with Cardiopulmonary Bypass

MicroRNA-1 (miR-1) is a cardio-specific/enriched microRNA. Our recent studies have revealed that serum and urine miR-1 could be a novel sensitive biomarker for acute myocardial infarction. Open-heart surgeries with cardiopulmonary bypass (CPB) are often accompanied with surgery injury and CPB-associated injury on the hearts. However, the association of miR-1 and these intra-operative and post-operative cardiac injures is unknown. The objective of this study was to test the hypothesis that urine and serum miR-1 might be a novel biomarker for myocardial injuries in open-heart surgeries with CPB. Serum and urine miR-1 levels in 20 patients with elective mitral valve surgery were measured at pre-surgery, pre-CPB, 60 min post-CBP, and 24h post-CBP. Serum cardiac troponin-I (cTnI) was used as a positive control biomarker for cardiac injury. Compared with these in pre-operative and pre-CPB groups, the levels of miR-1 in serum and urine from patients after open-heart surgeries and CPB were significant increased at all observed time points. A similar pattern of serum cTnI levels and their strong positive correlation with miR-1 levels were identified in these patients. The results suggest that serum and urine miR-1 may be a novel sensitive biomarker for myocardial injury in open-heart surgeries with CPB.     

Waiting for children��s surgery in Canada: the Canadian Paediatric Surgical Wait Times project

Background

In addition to possibly prolonged suffering and anxiety, extended waits for children’s surgery beyond critical developmental periods has potential for lifelong impact. The goal of this study was to determine the duration of waits for surgery for children and youth at Canadian paediatric academic health sciences centres using clinically-derived access targets (i.e., the maximum acceptable waiting periods for completion of specific types of surgery) as used in this Canadian Paediatric Surgical Wait Times project.

Methods

We prospectively applied standardized wait-time targets for surgery, created by nominal-group consensus expert panels, to pediatric patients at children’s health sciences centres across Canada with decision-to-treat dates of Sept. 1, 2007 or later. From Jan. 1 to Dec. 30, 2009, patients’ actual wait times were compared with their target wait times to determine the percentage of patients receiving surgery after the target waiting period.

Results

Overall, 27% of pediatric patients from across Canada (17411 of 64012) received their surgery after their standardized target waiting period. Dentistry, ophthalmology, plastic surgery and cancer surgery showed the highest percentages of surgeries completed past target.

Interpretation

Many children wait too long for surgery in Canada. Specific attention is required, in particular, in dentistry, ophthalmology, plastic surgery and cancer care, to address children’s wait times for surgery. Improved access may be realized with use of national wait-time targets.Prolonged wait times for care are often a concern in publicly funded health care systems.¹ Canadian governments have made the reduction of wait times a priority.^2,3 A Canadian federal–provincial accord, called the 2004 10-Year Plan to Strengthen Health Care, included a $5.5 billion wait-times reduction fund to help provincial and territorial governments reduce wait times in the five priority areas, which are cancer care, cardiac care, diagnostic imaging, joint replacement and sight restoration.³The focus of the fund, however, was almost exclusively relevant to adults, omitting Canada’s children and youth, who represent more than one-quarter of the Canadian population⁴ from the wait-time reduction priorities. To address wait times, governments in Canada have established central targets, such as the recommendation that surgery should be performed within six months of the decision to treat.² Although this approach is uniform and explicit, urgent surgery often requires a shorter time frame. An alternative approach to central targets is to have clinicians develop clinically derived access targets (i.e., maximum acceptable waiting periods for the completion of specific types of surgery).People are often surprised to learn that children wait for surgery just like adults.⁵ In addition to the possibility of prolonged suffering and anxiety that is typical of extended waits, surgery in children must sometimes be performed at critical developmental periods.⁶ Furthermore, adverse effects of extended waits may have lifelong impact, which magnifies the importance of measuring and addressing wait times in this vulnerable population. In 2006, the Pediatric Surgical Chiefs of Canada agreed to adopt standardized pediatric surgical wait-time access targets and resolved to measure the wait times for children’s surgeries. Thus, the Canadian Paediatric Surgical Wait Times project was founded as an unprecedented national collaborative effort. The goal of the project was to determine the duration of waits for surgery for children and youth at Canadian children’s centres in all surgical subspecialties, using clinically derived access targets.     

Trends in coronary artery bypass grafting in Ontario from 1981 to 1989.

OBJECTIVES: To determine the trends in overall and age-specific rates of coronary artery bypass grafting (CABG) in Ontario from 1981 to 1989 and to assess whether relative resource scarcity, as manifested in waiting lists, resulted in obvious age-related or sex-related changes in utilization. DESIGN: Computerized compilation of hospital discharge abstracts from the Hospital Medical Records Institute. All separations for every other year from Apr. 1, 1981, to Mar. 31, 1990, were included. Procedures rather than patients were the unit of analysis (repeat procedures were double-counted if associated with separate hospital admissions). SETTING: Ontario acute care hospitals offering CABG. PATIENTS: People aged 20 years and over who underwent one or more CABG procedures. RESULTS: The overall rate of CABG increased by 31% in the study period, plateauing only between 1983 and 1985. By 1989-90 the rate was 66.03 per 100,000. The highest annual increase in the rate was among people aged 65 to 74 years, at 17.61 procedures per 100,000, as compared with 4.64 per 100,000 among people 75 years and over. In 1989-90 those aged 65 and over represented 37% of the total caseload. The overall male:female ratio did not change significantly throughout the study period. CONCLUSIONS: Since the CABG utilization rate continues to increase in Ontario, recent waiting lists must be due to a disproportionate growth in demand. There was no convincing evidence of age-related or sex-related discrimination in allocating this limited resource. Supply-demand mismatch was driven above all by the continued increase in CABG use among elderly people.     

Automated knot tying for fixation in minimally invasive, robot-assisted cardiac surgery

Cardiovascular disease (CVD) is perhaps the most significant worldwide health issue. While open-heart surgery remains the predominant treatment, significant advancements have been made in minimally invasive surgery (MIS) and minimally invasive robot-assisted (MIRA) surgery. MIRA techniques offer many advantages over open-heart procedures and have extended the capabilities of MIS. However, these benefits come at the cost of increased operating times due to time spent tying knots. The additional bypass time limits patient access and is the most significant barrier to the adoption of MIRA techniques. This research seeks to overcome this barrier by designing a device for MIRA cardiac procedures that automates the knotting of sutures. If this task can be automated while ensuring the delivery of high-quality knots, great progress can be made in transforming the field. MIRA cardiac procedures can move from novel procedures performed by a select group of surgeons on a limited pool of patients to a viable alternative available to the majority of patients with CVD. In this research we propose a design for a self-contained device that delivers a locking knot. Results suggest that consistent knots can be delivered at a time savings of 12.5% and 26.4% over manual knots for trained and untrained users of a surgical robot, respectively.     

Focus: Rare Disease: Necrotizing Fasciitis: Association with Pregnancy-related Risk Factors Early in Life

Background: Pregnancy-related risk factors for necrotizing fasciitis are poorly understood. We investigated pregnancy-related characteristics associated with the long-term risk of developing necrotizing fasciitis, a rare life-threatening infectious disease. Methods: We analyzed a longitudinal cohort of 1,344,996 parous women in Quebec, Canada between 1989 and 2020. The main exposure measures included complications of pregnancy such as gestational diabetes, preterm delivery, metabolic disorder, and other maternal characteristics. We followed the women over time to identify future hospitalizations for necrotizing fasciitis up to three decades after delivery. We estimated adjusted hazard ratios (HR) and 95% confidence intervals (CI) for the association of pregnancy characteristics with risk of necrotizing fasciitis in time-varying Cox proportional hazards regression models. Results: A total of 420 women were hospitalized for necrotizing fasciitis during follow-up, including 83 (19.8%) with diabetes-related necrotizing fasciitis. The incidence of necrotizing fasciitis was elevated for women with gestational diabetes (2.9 per 100,000 person-years), preterm delivery (3.2 per 100,000 person-years), and metabolic disorders (5.4 per 100,000 person-years), compared with no pregnancy complication (1.1 per 100,000 person-years). Compared with no pregnancy complication, gestational diabetes was associated with 1.87 times the risk (95% CI 1.38-2.53), preterm delivery with 2.10 times the risk (95% CI 1.65-2.66), and metabolic disorder with 3.72 times the risk (95% CI 2.92-4.74) of developing necrotizing fasciitis over time. Pregnancy complications were more strongly associated with the risk of necrotizing fasciitis 5 years or more after delivery. Conclusions: Complications of pregnancy may be associated with the long-term risk of necrotizing fasciitis in women.     

Prospective pricing and DRGs.

In the Congenital Heart Program at San Diego Children''s Hospital, alterations in medical practice have reduced costs without impairing quality or access. Pediatric cardiac catheterization was done in 483 consecutive elective patients without overnight hospital stay. Hospital readmission was required in one patient for psoas tendinitis. Avoiding overnight hospital stay minimized attendant risks of hospital care, lessened psychosocial trauma and reduced the average hospital bill by $493 (29%). Hospital stay was also reduced for elective surgical correction of congenital heart disease on a case-by-case basis. Review of 151 consecutive cases (1978 through 1982) showed a decrease in both preoperative days in hospital and postoperative days in an intensive care unit. The duration of the postoperative stay was shortened from 6.8 days in 1978-1979 to 4.4 days in 1982 (P <.05). No increase in morbidity and no mortality resulted from the shortened perioperative hospital stay. Financial savings from this process averaged $991 per procedure.Diagnostic tests were reassessed and many precatheterization laboratory tests were eliminated. Without change in new patients seen or surgical volume, the use of cardiac catheterization decreased from 241 procedures in 1981 to 161 in 1982 and the number of operations without catheterization increased (11 to 22, 1981 to 1982). No increase in surgical morbidity or mortality was found comparing those diagnosed only by echocardiography with those who had preoperative cardiac catheterization. The decrease of 80 catheterizations in one year resulted in a savings of $188,800.True cost containment (reducing cost without reducing quality) can be accomplished in congenital heart programs. Similar cost containments in other disciplines may also be achieved.     

Recommended Criteria for Cardiac Catheterization in Patients with Aortic Valve Disease

Criteria for selection of patients with aortic valve disease for cardiac catheterization are described, based on a study of 81 cases. Children with aortic stenosis warrant catheterization at the time when the clinical diagnosis is made, but in adults this examination may be deferred until symptoms appear or left ventricular hypertrophy is recognized. In patients with pure aortic insufficiency catheterization may be deferred until symptoms appear. When severe stenosis and insufficiency co-exist, the valve is usually heavily calcified. Thirty-seven per cent of patients with aortic valve disease have co-existing mitral lesions and these patients are usually women, are fibrillating and, as a rule, have atrial enlargement in contrast to those with aortic valve disease only. On rare occasions, patients with mitral valve disease have clinically silent but angiographically demonstrable aortic insufficiency; therefore, aortography should precede open-heart correction of a mitral lesion so as to detect minor degrees of aortic insufficiency.     

Risk of HIV infection from blood transfusion in Montreal

OBJECTIVES: To determine the incidence (including associated donor characteristics and time trends) of HIV infection among repeat blood donors and to estimate the risk of HIV transmission from blood transfusion in Montreal and in Canada as a whole. DESIGN: Retrospective cohort analysis. SETTING: Montreal Centre Blood Transfusion Service. PARTICIPANTS: People who donated blood at least twice after Nov. 1, 1985, and at least once from Apr. 1, 1989, to Mar. 31, 1993. INTERVENTION: Blood was screened for HIV by enzyme-linked immunosorbent assay and results were confirmed by Western blot analysis. OUTCOME MEASURES: Incidence density (the incidence rate per person-time) of HIV infection among repeat blood donors by sex, age group and region of residence, and incidence density and risk among first-time donors and for Canada as whole. RESULTS: There were 200,196 eligible donors and 432,631 person-years (PY) of observation. From 1989 to 1993, there were 18 HIV seroconversions among repeat donors. The crude incidence density was 3.3 per 100,000 PY (95% confidence interval [CI] 1.8 to 5.4 per 100,000 PY); it was 4.9 per 100,000 PY among men and 0.61 per 100,000 PY among women. Age-specific incidence per 100,000 PY was 2.5 among those 12-29 years of age, 5.1 among those 30-49, 2.9 among those 40-49, and 1.4 among those 50 and older. Based on an estimated mean "window period" (from when a donor''s blood is capable of transmitting HIV until detectable antibody appears) of 25 days, the current risk of HIV infection from repeat donors in the window period is estimated at 1 in 440,000. Inclusion of blood units from first-time donors produces an overall risk of 1 in 390,000 (95% CI 1 in 250,000 to 655,000). The estimated risk per blood unit in Canada as a whole is 1 in 913000 (95% CI 1 in 507,000 to 2,050,000). CONCLUSIONS: This "sentinel" population of repeat blood donors is subject to important trends in HIV spread. Therefore, estimating the incidence density of HIV infection in repeat donors provides insight into the epidemiologic characteristics of HIV infection at minimal expense. As a result of measures to improve blood safety, including HIV testing, the incidence of HIV infection among blood donors in Canada is low and the risk of HIV transmission from transfusion is extremely small, although not zero.     

Should more hospitals in the Netherlands provide PCI without on-site cardiac surgery?

One of the main conclusions of the recent recommendations of the Health Council of the Netherlands is that the serious problems with waiting lists and inadequate access to timely cardiac surgical interventions have disappeared. Therefore, policy makers as well as the medical profession have concluded that the number of hospitals providing cardiac surgery in the Netherlands should remain stable. In view of the fact that the number of percutaneous coronary intervention (PCI) procedures has increased to around 30,000 a year and in the coming years will further increase to around 40,000 PCI procedures per year, a variety of practical solutions and a wide variety of opinions have been put forward.     

Utilization of sigmoidoscopy by family physicians in Canada.

OBJECTIVE: To determine the extent to which sigmoidoscopy is used as an investigative tool by family physicians in Canada. DESIGN: Retrospective study of data from provincial and territorial health agencies for the fiscal year 1989. SETTING: Canada. PARTICIPANTS: All family physicians. MAIN OUTCOME MEASURES: Number of physicians in each province and territory who performed sigmoidoscopy (flexible and rigid), type of physician (generalist or specialist), number of procedures performed, fee schedule and number of physicians billing medicare in each province and territory. RESULTS: During the study period 3849 (15.1%) of all family physicians performed rigid sigmoidoscopy; the proportion varied from 3.4% (in Quebec) to 40.0% (in the Northwest Territories). A total of 43,914 rigid sigmoidoscopies were performed by family physicians, representing 23% of all such procedures. Flexible sigmoidoscopy was performed by 381 (1.5%) of all family physicians; the proportion varied from 0.4% (in Quebec) to 6.8% (in Prince Edward Island). A total of 5361 flexible sigmoidoscopies were performed, representing 6.0% of all such procedures. CONCLUSION: The proportion of Canadian family physicians who are using sigmoidoscopy, rigid or flexible, as a diagnostic tool is low.     

Coronary revascularization after thrombolytic therapy for myocardial infarction: what caseloads could Canadian centres face?

A simple model was developed to project the potential effect of intravenous thrombolytic therapy on the caseloads of revascularization early after acute myocardial infarction. Published data were used to estimate the proportion of infarct patients eligible for thrombolytic treatment and their subsequent rates of percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass surgery (CABS) within 2 weeks and up to 6 to 12 weeks after treatment. Toronto regional caseload data were obtained from registries and hospital discharge records. Our primary projections, based only on coronary angiography for evidence of spontaneous or exercise-induced ischemia, suggest a 165% increase in the post-thrombolysis use of PTCA within 2 weeks of infarction and even greater increases 6 to 12 weeks after infarction. Adding in selective use of salvage PTCA for some patients with persisting pain despite thrombolysis increases the overall PTCA caseload within 2 weeks by 242%. Data on the current caseload of post-thrombolysis CABS are unavailable. However, our projected caseload for the 30% of infarct patients treated with thrombolytic drugs equals or exceeds the current number of CABS procedures performed on all infarct patients within a month of the event. All these projections are conservative, in that they consider neither procedures 3 to 12 months after infarction nor restenosis after PTCA. This analysis illustrates that current approaches to revascularization after thrombolytic therapy could have a substantial effect on PTCA and CABS caseloads. Further studies with improved caseload data are needed to validate these preliminary projections.     

Coronary artery bypass graft surgery in Newfoundland and Labrador

BACKGROUND: Newfoundland and Labrador, like other health care jurisdictions, is faced with widening gaps between the demands for health care and a strained ability to supply the necessary resources. The authors carried out a study to determine the rates of appropriate and inappropriate coronary artery bypass grafting (CABG) in the province and the waiting times for this surgery. METHODS: This retrospective cohort study was performed in the tertiary care hospital that receives all referrals for coronary angiography and coronary artery revascularization for Newfoundland and Labrador. By reviewing the hospital records, the authors identified 2 groups of patients: those in whom critical coronary artery disease was diagnosed on the basis of coronary angiography and who were referred for CABG between Apr. 1, 1994, and Mar. 31, 1995, and those who actually underwent the procedure during that period. By applying specific criteria developed by the RAND Corporation, the authors determined the appropriateness and necessity of CABG in each case. They also compared waiting times for CABG with optimal waiting times; as determined by a consensus-based priority score. RESULTS: A total of 338 patients underwent CABG during the study period. The cases were characterized by multivessel disease and late-stage angina symptoms. Almost all of the patients had high appropriateness scores (7-9), and nearly 95% had high necessity scores (7-9). However, during the study period, the waiting list increased by about 20%, because a total of 391 patients were referred by the weekly cardiovascular surgery conference; the authors identified these and an additional 31 patients as having necessity scores of 7 or more. Only 7 (23%) of 31 patients for whom CABG was considered very urgent underwent surgery within the recommended 24 hours, and only 30 (24%) of the 122 patients for whom CABG was considered urgent underwent surgery within the recommended 72 hours. INTERPRETATION: These results provide evidence that the cardiac surgery program in Newfoundland and Labrador is performing CABG in patients for whom surgical revascularization is highly appropriate and necessary. Access to CABG is less than ideal, however, since the waiting list continues to expand, and many patients wait beyond the recommended time for surgery.     

Impact of cancer surgery slowdowns on patient survival during the COVID-19 pandemic: a microsimulation modelling study

Background:With the declaration of the global pandemic, surgical slowdowns were instituted to conserve health care resources for anticipated surges in patients with COVID-19. The long-term implications on survival of these slowdowns for patients with cancer in Canada is unknown.Methods:We constructed a microsimulation model based on real-world population data on cancer care from Ontario, Canada, from 2019 and 2020. Our model estimated wait times for cancer surgery over a 6-month period during the pandemic by simulating a slowdown in operating room capacity (60% operating room resources in month 1, 70% in month 2, 85% in months 3–6), as compared with simulated prepandemic conditions with 100% resources. We used incremental differences in simulated wait times to model survival using per-day hazard ratios for risk of death. Primary outcomes included life-years lost per patient and per cancer population. We conducted scenario analyses to evaluate alternative, hypothetical scenarios of different levels of surgical slowdowns on risk of death.Results:The simulated model population comprised 22 799 patients waiting for cancer surgery before the pandemic and 20 177 patients during the pandemic. Mean wait time to surgery prepandemic was 25 days and during the pandemic was 32 days. Excess wait time led to 0.01–0.07 life-years lost per patient across cancer sites, translating to 843 (95% credible interval 646–950) life-years lost among patients with cancer in Ontario.Interpretation:Pandemic-related slowdowns of cancer surgeries were projected to result in decreased long-term survival for many patients with cancer. Measures to preserve surgical resources and health care capacity for affected patients are critical to mitigate unintended consequences.

Declaration of the global COVID-19 pandemic led to the implementation of several clinical and policy-related measures to mitigate risk to vulnerable populations and conserve health care resources. Literature from early waves of the pandemic characterized patients with cancer as a vulnerable population.^1,2 Moreover, cancer surgery can be highly resource intensive, which could strain the health care system’s ability to respond to the pandemic. Accordingly, in March 2020, the Ontario government recommended reducing the number of cancer surgeries, along with other elective surgeries performed in the province. These measures were aimed at reducing both patient morbidity and use of health care resources, primarily by decreasing routine postoperative admissions to wards and intensive care units, in anticipation of a potential surge of patients with COVID-19.³Although necessary, this initial strategy resulted in a backlog of cancer surgeries, and some patients faced longer wait times to surgical treatment.⁴ Given clear evidence showing that longer surgical wait times can increase cancer-related risk of death, there is concern for the unintended consequences of the surgical slowdowns during the COVID-19 pandemic.^5–8 International data have projected the negative impact on long-term survival associated with potential delays to cancer diagnosis or surgery across various cancer types.^9–11 Recognizing the global differences in level of infection, response to the COVID-19 pandemic and cancer survival rates, country-specific data are required to understand local consequences and better guide future responses to times of resource constraint. As such, the objective of the current study was to evaluate the long-term implications of pandemic–related cancer surgery slowdowns on cancer survival in Ontario, Canada.