With more than 4,200 elective surgeries on the wait list at Health Sciences North (HSN) in Sudbury, it will be a busy fall as Northern Ontario's largest hospital tries to catch up with the backlog.
It is just as urgent at Thunder Bay's Regional Health Sciences Centre, where there is a backlog of 4,000 surgeries. Most of the elective and non-urgent surgeries were cancelled as a result of the COVID-19 pandemic as hospitals wanted to ensure they had critical care beds available.
One thing that has not been officially measured, but is of significant importance, is the impact of lengthy waiting on the mental health of patients according to a recent article in the Canadian Journal of Surgery.
The article, submitted by Sam M. Wiseman, MD; Trafford Crump, PhD; Eric Cadesky, MDCM and Jason M. Sutherland, PhD, said although little attention is being paid to the mental health of patients who have to wait unusually long periods for their surgery, there is indeed an impact.
The study noted that as Canadian hospitals are “ramping up” their elective operations, governments, hospital administrators, surgeons and referring doctors have limited evidence-based tools for prospectively prioritizing people who are waiting for surgery.
The study mentioned that since 2012, the patients waiting for elective surgery in B.C. were surveyed about their mental health and wellness by the Vancouver coastal Health Authority, Providence Health Care and the University of British Columbia.
"The results document that depression, anxiety, pain and insomnia are common in people waiting for an elective operation," said the article.
It also suggested that depression and substance abuse has increased for patients on wait lists.
"About 20 per cent of Canadians experience mental illness in any given year, and rates of anxiety, depression and substance abuse have increased since the start of the pandemic.
The article also noted that in Ontario, Alberta and British Columbia, plans have recently been revealed for catching up on backlogged surgeries and that priorities are based on diagnosis.
"This means that surgeons must perform a manual override to reflect patients’ symptom severity or pain. Better supports are needed to allow surgical teams to properly assess not only patients’ physical health, but also their mental health, and provide them with timely access to care based on need," said the article.
The article also suggested that the practice of the Vancouver Coastal Health Authority should be copied by other health jurisdictions in Canada so that patient-reported outcomes could be used to periodically screen the mental health of patients and provide the opportunity for further assessments and interventions.
"Surgical teams could also screen patients in their own practices to increase awareness of the impact of waiting on their patients’ mental health. In turn, this information could be used to help inform prioritization strategies.”
The article concluded with the suggestion that medical professionals need to work harder to recognize that many patients may be having problems by being stuck on a wait list that can last several months.
"We need to consider that many surgeries labelled “elective” or “nonurgent” are crucial to the quality of life and function of the patients waiting for them. To provide the best care possible, we need to recognize, measure and address both the physical and mental health problems of our patients. With coordinated effort, we can work together so that “whole-person” preoperative care emerges as a positive legacy during Canada’s recovery from COVID-19.
In Ontario, the Ministry of Health has provided online references for citizens who feel the need to access mental health services.