Using Pathology Data to Evaluate Surgical Backlogs: Considerations for Resource Planning
References
1 Jonathan Wang, Saba Vahid, Maria Eberg, et al. Clearing the surgical backlog caused by COVID-19 in Ontario: a time series modelling study. CMAJ 2020;192:E1347-E1356.
2 https://www.ontariohealth.ca/sites/ontariohealth/files/2020-04/Ontario%20Health%20Cancer%20Care%20Ontario%20COVID-19%20Supplemental%20Clinical%20Guidance%20for%20Patients%20with%20Cancer_29Mar20%20PDF.pdf
Wang et al provided valuable insight into the impact of COVID-19, estimating a backlog of 148,364 surgeries in Ontario from Mar-Jun 2020.(1) Expanding on the issues they raised, we would like to highlight important additional considerations.
We reviewed surgical pathology and CCO summary data from the London Health Sciences Centre and St. Joseph’s Health Care in London, ON. In Apr 2020, the total number of accessioned specimens decreased compared to April 2019 by 67.5% (2820 vs 8668), while resection specimens decreased by 51.4% (524 vs 1078). CCO report submissions, largely reflecting newly staged cancer cases, decreased by 30.5% (169 vs 243). The relatively modest drop in resections and CCO submissions relative to total specimens likely reflects efforts to prioritize cancer surgeries.
In the Apr-Jun 2020 period, the gap compared to 2019 decreased as surgeries resumed. Total specimens were reduced by 47.4% (13,842 vs 26,303), compared to 30.9% for resections (2304 vs 3335) and 11.3% for CCO submissions (643 vs 725). Of note, reductions in CCO submissions varied between disease sites. While volumes were comparable for breast cancer (170 vs 171) and colon cancer (73 vs 76), there were drops of 71.6% (19 vs 67) and 53.2% (29 vs 62) for lung and prostate cancers, respectively. These differences may be due to triaging based on patient, clinical, safety and resource factors.(2) We suspect regional variations and surgery reductions have limited cancer procedures to high-risk cases and may have resulted in underserviced areas.
It is important that biopsy services are maintained to identify patients who require prompt treatment. Typically performed in settings such as endoscopy suites and clinics, biopsy volumes in April to June were variably decreased between disease sites, with colorectal biopsies down 63.7% (2013 vs 5553), compared to 24.4% for breast biopsies (374 vs 495) and 23.9% for prostate biopsies (730 vs 959).
Service reductions due to COVID-19 resulted in decreased surgical resection, cancer reporting and biopsy volumes. Variable effects between disease sites may highlight gaps in care; resource planning to address such gaps should ensure patients have fair and equitable access to health care resources. The surgical backlog impact also extends beyond operating rooms and the health care sector, including pressures on primary care, long-term care homes and ability to return to work. We recognize that COVID-19 will continue to affect surgical activity, particularly when pressures on the acute sector grow from COVID-19-related outbreaks and admissions. As system leaders grapple with hospital capacity and demand, we encourage that system-wide risk assessments be undertaken. Prompt and targeted investments to expand diagnostic and surgical activity through all possible care settings will likely pay long-term dividends. Delays in addressing this challenge until after COVID-19 not only allows for symptoms to escalate, but will also be costly.