Orthopedic surgery in Canada: Most had positive outcomes, but one-in-four found the wait too long

In B.C., the number of patients reporting ‘unreasonable’ wait times jumps to one-in-three

July 24, 2017 – As news reports profile orthopedic surgery patients frustrated with lengthy wait-times, a unique Angus Reid Institute survey of more than 1,500 Canadians who have undergone orthopedic surgery within the last ten years finds large majorities satisfied with their surgeon, hospital, and surgery outcome, but a significantly smaller number satisfied with the amount of time they had to wait.

More than one-in-five say they waited an “unreasonable” amount of time for treatment, a number that suggests more than 300,000 Canadians have experienced unreasonable waits for orthopedic surgery in the last decade.

In British Columbia, where Dr. Brian Day is challenging the provincial government over his Cambie Surgery Clinic’s right to charge patients for surgery, the percentage reporting an unreasonable wait time rises to one-in-three (34%).

Fully half (51%) of those who deem their wait time unreasonable waited more than a year for treatment. If they had to do it again, more than one-in-three of these patients (36%) would pay out-of-pocket in order to speed things up.

Key Findings:

One-in-six orthopedic surgery patients who found their wait times unreasonable (17%) were on waiting lists for two years or more before their operations. Half (51%) waited at least a year, and fully eight-in-ten (81%) waited longer than the Canadian Institute for Health Information’s benchmark of six months

More than one-in-three who had unreasonable wait times (36%) say they would pay their own money to speed up the process if they needed orthopedic surgery again in the future

Orthopedic surgery patients are split on the value of private surgery clinics, with 49 per cent saying they are a good thing, overall, and the rest (51%) saying they’re a bad thing

Index:

Part 1 – More than one-in-five had ‘unreasonable wait times

Part 2 – Paying for faster service?

Part 3 – Most are satisfied with hospitals, surgeons, and outcomes

More than one-in-five had ‘unreasonable’ wait times

According to the Canadian Institute for Health Information, 73 per cent of knee replacements and 79 per cent of hip replacements were completed within the benchmark time frame of 182 days (six months) in 2016. Wait time statistics for other orthopedic surgery procedures are not reported on the CIHI website.

These two joints – knees and hips – are the among most common areas for orthopedic surgery, and the volume of such procedures has been increasing as Canada’s population ages.

This Angus Reid Institute survey is one of the largest of its type undertaken in Canada. Among the 1,512 people surveyed – all of whom have undergone orthopedic surgery in the last decade or are currently waiting for a procedure – roughly half (49%) had a knee operation, and another one-in-five (21%) had a hip procedure. Fewer than one-in-ten respondents underwent each of the other types of orthopedic surgery canvassed in this survey (see comprehensive tables for greater detail).

More than one-in-five patients who had orthopedic surgery of any type in the last ten years report finding the amount of time they waited “unreasonable.” This includes 7 per cent who found the wait “very unreasonable,” as seen in the graph that follows.

Among respondents in British Columbia, the percentage who report unreasonable wait times rises to one-in-three (34%), higher than in any other region:

*small sample sizes

This finding correlates somewhat with CIHI data on knee and hip replacement wait times in British Columbia. While the national averages are 73 and 79 per cent of procedures, respectively, completed within the benchmark time, the percentage of procedures meeting the benchmark in British Columbia is 61 per cent for hip replacements, and just 47 per cent for knee replacements.

That said, data from other provinces doesn’t correlate quite as well with the perceived reasonableness of wait times. Nova Scotia and New Brunswick, for example, have similarly low proportions of knee and hip replacements meeting the benchmark time, but patients in the Atlantic region are among the most likely to say their wait times were reasonable.

Likewise, Alberta beats the national average for meeting benchmark wait times on both knee and hip replacement procedures, but Alberta patients are almost as likely to find wait times unreasonable as British Columbians.

Whatever a patient’s reason for believing their wait was unreasonable, this survey confirms that they are not alone. Extrapolating from publicly available data on the number of knee and hip procedures conducted in Canada in the last 10 years (a total of slightly less than 1 million), this study suggests that more than 300,000 people who had orthopedic surgery of any type (knee, hip, or other) in this country in the last decade waited an unreasonable amount of time to get it.

It should be noted that a variety of factors beyond region influence responses on this question. Generally speaking, patients who had operations on a part of their body other than a knee or hip are more likely to say their wait time was “very reasonable,” as seen in the following graph:

The reason for receiving orthopedic surgery also correlates with the perceived reasonableness of the wait time. Patients requiring treatment for traumatic injuries caused by accidents – whose surgery needs are often considered urgent – are more likely to say their wait time was “very reasonable.”

Those who waited an amount of time they felt was unreasonable were asked a follow-up question about how long they waited. Half (51%) say they waited at least a year, including one-in-six (17%) who waited two years or more for surgery. Another three-in-ten waited more than the benchmark six months, as seen in the following graph:

Asked what length of time would have been reasonable, half (50%) of those who reported unreasonable waits for surgery said “1 – 3 months,” and nearly all respondents picked a number below the benchmark six-month wait time, as seen in the following graph:

Paying for faster service?

Given the proportion of orthopedic surgery patients who found their wait-times for surgery unreasonable, respondents were also asked whether they would be willing to spend their own money to speed up the process.

Private clinics that conduct orthopedic surgery can be found across the country, and are sometimes tasked by provincial governments to operate on those who have been waiting too long in the public system. Generally, these clinics also allow patients to pay for their surgery out of pocket, though hardly any of the patients surveyed in this study spent money on their procedure. Fully 96 per cent say they did not pay for their most recent orthopedic surgery, and only 1 per cent say they payed the full cost (the rest either paid part of the cost or could not recall).

Asked to suppose they needed orthopedic surgery again, and had the option to speed up the process by paying for it out of pocket, more than seven-in-ten respondents (72%) say they would choose not to pay. This includes nearly two-thirds of those whose wait times for their most recent surgery were “unreasonable,” as seen in the graph that follows.

That said, it’s notable that more than one-third who had unreasonable wait times would pay, and one-in-five say they would spend $1,000 or more in order to speed up a future surgery:

Perhaps surprisingly, given their greater willingness to pay out of pocket for a future orthopedic surgery, those who had an unreasonable wait time are not significantly more likely than those who had reasonable waits to say private surgery clinics are a good thing, overall:



One factor that does appear to influence both views on private clinics and willingness to pay for surgery is political orientation. Those respondents who voted for the Conservative Party of Canada in the 2015 federal election are more likely to say they would be willing to pay their own money for a future surgical procedure (36% would, compared to 26% of Liberal Party supporters and 20% of New Democratic Party voters surveyed).

Fully two-thirds (66%) of surveyed patients who voted for the Conservatives say private clinics are a good thing, while majorities who supported the other two major parties choose the opposite response:

Regionally, respondents in Quebec are more likely than those in other regions to view private clinics positively, a finding possibly attributable to the province’s status as the home of the first private diagnostic machines in the country, or to the key role Quebec played in a landmark Supreme Court of Canada ruling ending government bans on private health insurance.

Whatever the reason, Quebec is something of an outlier on this question. Neighbouring Ontario is one of regions most likely to view private surgery clinics negatively:

*small sample size

Also especially inclined to favour private clinics? Respondents with higher incomes, who are more likely to have the means to pay for surgery with their own money.

Most are satisfied with surgeons, facilities, and outcomes

While this survey suggests there is considerable room for improvement when it comes to wait times for orthopedic surgery in Canada, it also finds broad satisfaction on the part of patients when it comes to other aspects of the process.

Asked to rate the success or failure of their orthopedic surgery procedure, the vast majority of patients deem it to be either a partial (34%) or a total success (56%). Fewer than one-in-ten say their most recent orthopedic surgery was a partial failure (8%), and only 2 per cent say the surgery was a total failure.

Those who had hip surgeries are especially likely to rate the experience as a total success, but the percentage of respondents reporting that their last surgery was a partial or total failure remains consistently low regardless of what part of their body was the subject of the operation:

In a similar vein, when asked whether they were satisfied or dissatisfied with various aspects of the orthopedic surgery process, more than eight-in-ten respondents express satisfaction with each one, except for wait times:

As might be expected, those who found their wait times unreasonable also overwhelmingly say they are dissatisfied with wait times. Notably, however, this dissatisfaction does not turn into a pattern. Those who had unreasonable wait times are not significantly less satisfied with the outcome of the surgery, the doctor, or the hospital. Indeed, more than eight-in-ten of them (83%) say they were satisfied with the orthopedic surgery process overall, despite their unreasonable wait (see summary tables at the end of this release for greater detail).

The Angus Reid Institute (ARI) was founded in October 2014 by pollster and sociologist, Dr. Angus Reid. ARI is a national, not-for-profit, non-partisan public opinion research organization established to advance education by commissioning, conducting and disseminating to the public accessible and impartial statistical data, research and policy analysis on economics, political science, philanthropy, public administration, domestic and international affairs and other socio-economic issues of importance to Canada and its world.

MEDIA CONTACTS:

Click here for the full report including tables and methodology

Click here for comprehensive data tables

Click here for the questionnaire used in the survey

MEDIA CONTACTS:

Shachi Kurl, Executive Director: 604.908.1693 shachi.kurl@angusreid.org @shachikurl

Ian Holliday, Research Associate: 604.442.3312 ian.holliday@angusreid.org

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