COVID-related delays in non-urgent adult surgeries: comparing population-based results from two Canadian provinces.

Background: During the COVID-19 pandemic, non-urgent surgeries were delayed in order to increase the capacity to care for patients with COVID-19. To shed light on the effect of pandemic-related surgical ramp down on the quality of surgical care, this study compared Ontario with Alberta on (1) changes in the proportion of completion and wait time of surgeries with decision-to-treat in a pre-pandemic period compared to those with decision-to-treat in each of the four COVID-19 waves and (2) shifts in healthcare utilization and safety of surgical patients for the same time periods. Methods: A retrospective population-based cohort study was conducted in Ontario on scheduled non-urgent surgeries among adults with decision-to-treat (index dates) between January 1, 2018 and December 31, 2021. Logistic regression was used to examine surgery completion (observed up to December 31, 2021) on the index date period (each COVID-19 wave vs. pre-pandemic). For completed surgeries, median regression was used to assess wait time on the index date period. Descriptive statistics were provided on healthcare utilization and safety indicators among the cohort. Results from regression models and descriptive statistics were then compared with published data from Alberta. Results: There were 2,073,688 non-urgent surgeries scheduled for 1,560,265 unique adults in Ontario. Surgeries with an index date in each COVID-19 wave were associated with lower odds of completion compared to the pre-pandemic period, which is in contrast to Alberta where the odds of having surgery completed was not lower during the pandemic than pre-pandemic. Among completed surgeries (91.7%) in Ontario, the median wait time was shorter for surgeries with an index date in waves 2 and 4 than in the pre-pandemic period, while in Alberta the median wait time was shorter for surgeries with index dates in waves 2-4 than pre-pandemic. During the pandemic, Alberta reported a decrease in median intensive care unit (ICU) hours and hospital length of stay for patients relative to pre-pandemic, while Ontario reported an increase in median ICU hours of these patients. Conclusions: These findings highlight interprovincial differences in surgical care which might be related to COVID-19 policies in each province, healthcare system capacity and patient demographics.