The burden of waiting: wait times for pediatric surgical procedures in Quebec and compliance with national benchmarks

Abstract

Background: Wait time information and compliance with national guidelines are limited to a few adult conditions in the province of Quebec. We aimed to assess compliance with Paediatric Canadian Access Targets for Surgery (P-CATS) guidelines and determine the burden incurred due to waiting for 3 common elective surgical conditions (inguinal hernia, cryptorchidism and hypospadias) in a pediatric population. Methods: We carried out a population-based retrospective cohort study of randomly selected children residing in Quebec without complex chronic medical conditions, using administrative databases belonging to the Régie de l’assurance maladie du Québec for the period 2010–2013. Disability-adjusted life years (DALYs) were calculated to measure the burden due to waiting. Multivariate forward regression identified risk factors for compliance with national guidelines. Results: Surgical wait time information was assessed for 1515 patients, and specialist referral wait time was assessed for 1389 patients. Compliance with P-CATS benchmarks was 76.6% for seeing a specialist and 60.7% for receiving surgery. Regression analysis identified older age (p < 0.0001) and referring physician specialty (p = 0.001) as risk factors affecting specialist referral wait time target compliance, whereas older age (p = 0.040), referring physician specialty (p = 0.043) and surgeon specialty (p = 0.002) were significant determinants in surgical wait time compliance. The total burden accrued due to waiting beyond benchmarks was 35 DALYs. Conclusion: Our results show that provincial compliance rates with wait time benchmarks are still inadequate and need improvement. Patient age and physician specialty were both found to have significant effects on wait time target compliance.

Are we still too late? Timing of orchidopexy

“…Access to surgery and the type of hospital in which the child is treated also played a role for timing. Despite early referral, waiting for surgery can result in a delay in treatment [33]. In Germany, the rate of early orchidopexy was significantly higher in hospitals with pediatric surgical departments than without [28].…”

Elective pediatric surgery: profile description of children and late referral identification

“…In addition to the negative psychological and social effects caused by this wait, there is also the negative economic effect arising from the need for additional interventions and hospitalizations due to the underlying pathology. Furthermore, the consequences of the delay in performing the surgery and the result obtained with the treatment may be impaired due to the delay in the procedure 22 . Around five billion people throughout the world, including children and adults, do not have safe access to surgical and anesthetic procedures when needed 23 .…”

“…Many factors are known to be associated with precarious care for children, especially in underdeveloped countries, such as poor transport conditions, distances between large centers and small towns in the interior, poverty, lack of knowledge of those responsible for the children, cultural beliefs, impossibility of funding of health procedures by families, limitation in the number and location of specialized care centers, limitation in the availability of specialists, difficulties in carrying out complementary exams, and low availability of safe pediatric anesthesia 23 . Even in developed countries such as Canada, it has recently been shown that compliance rates regarding waiting times for surgical procedures in pediatrics are far from ideal and that additional efforts are needed to improve the proportion of patients seen in reference targets 22 .…”

Assessment of Multiple-Opinion Referrals and Consults at the BC Children’s Hospital Allergy Clinic

“…2 Provinces are struggling to meet these targets, with a recent analysis in Quebec highlighting rurality of patients, age of patients, number of visits, and referring-physician specialty as signi cant barriers to specialist referral in target time. 3 While current studies and national guidelines are limited, these barriers to accessing care for the pediatric population can be extended to other services outside of surgery.…”

“…2 Provinces are struggling to meet these targets, with a recent analysis in Quebec highlighting rurality of patients, age of patients, number of visits, and referring-physician specialty as signi cant barriers to specialist referral in target time. 3 While current studies and national guidelines are limited, these barriers to accessing care for the pediatric population can be extended to other services outside of surgery.Pediatric allergy serves as an important lens of focus for examining barriers to accessing specialty care services and patient wait times, in light of the steadily rising prevalence of atopic disease in Canada, with 27.3% of Canadians aged twelve or older reporting having allergic disease con rmed by allergy testing in 2017. 4 Canada and other developed countries have a higher burden of allergic disease relative to the developing world, due in part to genetics, unique aeroallergens, climate, and other factors such as hygiene and microbiome in uences.…”