1. Surgeon- and hospital-level variation in wait times for scheduled non-urgent surgery in Ontario, Canada: A cross-sectional population-based study.
- Author
-
de Jager, Pieter, Aleman, Dionne, Baxter, Nancy, Bell, Chaim, Bodur, Merve, Calzavara, Andrew, Campbell, Robert, Carter, Michael, Emerson, Scott, Gagliardi, Anna, Irish, Jonathan, Martin, Danielle, Lee, Samantha, SaxeBraithwaite, Marcy, Seyedi, Pardis, Takata, Julie, Yang, Suting, Zanchetta, Claudia, and Urbach, David R.
- Subjects
ELECTIVE surgery ,RANDOM effects model ,KNEE surgery ,UTERINE surgery ,TOTAL hip replacement - Abstract
Background: Canadian health systems fare poorly in providing timely access to elective surgical care, which is crucial for quality, trust, and satisfaction. Methods: We 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. Results: A 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. Implications: There 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. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF