PLoS ONE (Jan 2024)

Surgeon- and hospital-level variation in wait times for scheduled non-urgent surgery in Ontario, Canada: A cross-sectional population-based study.

  • Pieter de Jager,
  • Dionne Aleman,
  • Nancy Baxter,
  • Chaim Bell,
  • Merve Bodur,
  • Andrew Calzavara,
  • Robert Campbell,
  • Michael Carter,
  • Scott Emerson,
  • Anna Gagliardi,
  • Jonathan Irish,
  • Danielle Martin,
  • Samantha Lee,
  • Marcy SaxeBraithwaite,
  • Pardis Seyedi,
  • Julie Takata,
  • Suting Yang,
  • Claudia Zanchetta,
  • David R Urbach

DOI
https://doi.org/10.1371/journal.pone.0307845
Journal volume & issue
Vol. 19, no. 8
p. e0307845

Abstract

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BackgroundCanadian health systems fare poorly in providing timely access to elective surgical care, which is crucial for quality, trust, and satisfaction.MethodsWe conducted a cross-sectional analysis of surgical wait times for adults receiving non-urgent cataract surgery, knee arthroplasty, hip arthroplasty, gallbladder surgery, and non-cancer uterine surgery in Ontario, Canada, between 2013 and 2019. We obtained data from the Wait Times Information System (WTIS) database. Inter- and intra-hospital and surgeon variations in wait time were described graphically with caterpillar plots. We used non-nested 3-level hierarchical random effects models to estimate variation partition coefficients, quantifying the proportion of wait time variance attributable to surgeons and hospitals.ResultsA total of 942,605 procedures at 107 healthcare facilities, conducted by 1,834 surgeons, were included in the analysis. We observed significant intra- and inter-provider variations in wait times across all five surgical procedures. Inter-facility median wait time varied between six-fold for gallbladder surgery and 15-fold for knee arthroplasty. Inter-surgeon variation was more pronounced, ranging from a 17-fold median wait time difference for cataract surgery to a 216-fold difference for non-cancer uterine surgery. The proportion of variation in wait times attributable to facilities ranged from 6.2% for gallbladder surgery to 23.0% for cataract surgery. In comparison, surgeon-related variation ranged from 16.0% for non-cancer uterine surgery to 28.0% for cataract surgery.ImplicationsThere is extreme variability in surgical wait times for five common, high-volume, non-urgent surgical procedures. Strategies to address surgical wait times must address the variation between service providers through better coordination of supply and demand. Approaches such as single-entry models could improve surgical system performance.