Province adding loads of lipstick on its orthopedic surgery pig By: Tom Brodbeck Posted: 3:19 PM CST Thursday, Dec. 29, 2022 Last Modified: 3:13 PM CST Thursday, Dec. 29, 2022 Updates

Opinion

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This article was published 28/12/2022 (727 days ago), so information in it may no longer be current.

It’s no surprise wait times for hip and knee surgeries in Manitoba have climbed this year.

Despite claims by Premier Heather Stefanson’s government that it’s “building capacity” in the system to increase surgical slates, the number of completed monthly orthopedic procedures in Manitoba has been falling since the summer.

That’s bad news, not only because the province is nowhere near clearing the backlog of cases that piled up during the COVID-19 pandemic, but also since demand for hip and knee replacements continues to grow every year.

The number of monthly hip-replacement surgeries grew during the first part of 2022, peaking at 222 in May.

However, completed cases have dropped every month since, falling to 177 in October, according to Manitoba’s diagnostic and surgical recovery dashboard. That’s below the 191 hip surgeries performed during the same month in 2019, before the pandemic.

The situation is similar for knee-replacement surgery: the monthly number of completed cases peaked in August at 305 and fell to 276 in October. There were 283 knee surgeries performed in October 2019.

Hip and knee surgeries in 2022 have already surpassed volumes in 2020 and 2021, when thousands of surgeries and diagnostic tests were cancelled as health-care staff were redeployed to treat COVID-19 patients.

However, at current rates, hip and knee surgeries this year may barely reach levels achieved in 2019, when 5,049 cases were completed (which includes revisions — followup surgery when something goes wrong with a procedure). By October of this year, 4,163 hip and knee surgeries were completed.

That level of output will do little to clear the pandemic backlog, which has been stuck at 1,140 cases since August (after falling from 1,557 in January).

The challenge for orthopedic surgeons is that demand for joint replacements increases every year, owing to a growing and aging population. Manitoba’s 2017 wait-time task force estimated that demand for hip and knee replacement surgeries is growing by an estimated five per cent a year. That estimate is also used by the diagnostic and surgical recovery task force to project future demand.

Under that calculation, Manitoba would have to perform 5,845 hip and knee surgeries in 2022 just to keep pace with growing demand (and 6,137 in 2023). The province would have to exceed those amounts to clear the pandemic backlog. Based on volumes this year, Manitoba would be lucky to hit 5,000 in 2022.

Out-of-province surgeries may help a bit. None of the completed cases on the task force dashboard include procedures performed outside of Manitoba, although there haven’t been many.

The province has agreements with clinics in northwestern Ontario, Fargo and Cleveland to provide hip and knee replacement surgeries for willing and eligible Manitobans already on a wait list.

However, fewer than 60 have been performed at those clinics so far this year, and only 90 more patients have signed up.

All of which explains why wait times were longer in October than in January for both hip and knee surgeries.

The median wait time for hip replacement in October was 25 weeks, up from 21 in January. The wait time for knee surgery was 37 weeks in October, an increase from 29 in January.  Many people wait longer than the posted times; some get in sooner. The figures represent the point at which half of people wait longer and half wait less.

The delay for some can be as long as two years or more (which may also include the time it takes to get referred to a surgeon, which is not included in government’s official wait-time data).

So how does government expand capacity to bring down wait times in the face of growing demand for orthopedic surgery? Hospitals need more surgeons, nurses and other health-care staff.

Concordia Hospital is scheduled to open a new operating room for orthopedics in April. The province says that will add up to 1,000 more hip and knee procedures a year.

However, what isn’t clear is where they’re getting the surgeons and staff to increase those volumes (or whether they’re simply shifting resources from one hospital to another).

Presumably we’ll get more details early in the new year.

In the meantime, wait times are not expected to get shorter any time soon.

tom.brodbeck@freepress.mb.ca