Predicted backlog in ophthalmic surgeries associated with COVID-19 pandemic in Ontario: A time series modelling analysis

Track:
Public Health and Global Ophthalmology
What:
Paper Presentation | Présentation d'article
When:
11:32 AM, Sunday 12 Jun 2022 (6 minutes)
Where:
How:

Authors: Yaping Jin, Mayilee Canizares, Sherif El-Defrawy, Yvonne Buys.

Author Disclosure Block: Y. Jin: Funded grants or clinical trials; Name of for-profit or not-for-profit organization(s); Ontario’s Ministry of Health for the COVID-19 Challenge Questions Initiative., Glaucoma Research Society of Canada. Funded grants or clinical trials; Description of relationship(s); Grant/Research support, Grant/Research support. M. Canizares: Funded grants or clinical trials; Name of for-profit or not-for-profit organization(s); Ontario’s Ministry of Health for the COVID-19 Challenge Questions Initiative. Funded grants or clinical trials; Description of relationship(s); Grant/Research support. S. El-Defrawy: Funded grants or clinical trials; Name of for-profit or not-for-profit organization(s); Ontario’s Ministry of Health for the COVID-19 Challenge Questions Initiative.. Funded grants or clinical trials; Description of relationship(s); Grant/Research support. Y. Buys: Funded grants or clinical trials; Name of for-profit or not-for-profit organization(s); Ontario’s Ministry of Health for the COVID-19 Challenge Questions Initiative., Glaucoma Research Society of Canada. Funded grants or clinical trials; Description of relationship(s); Grant/Research support, Grant/Research support.

Abstract Body:


Purpose: Health systems’ responses to the coronavirus disease 2019 (COVID-19) pandemic created a surgical backlog of unknown size. This unknown information limits the ability to develop strategies to effectively address the backlog. We assessed the volume of deferred ophthalmic surgeries associated with the COVID-19 pandemic from March-December 2020 and suggested strategies and duration to clear the backlog in Ontario, Canada.
Study Design: Cross-sectional study.

Methods: Ontario Health Insurance Plan physician billing data from 2017-2020 were analyzed. The ophthalmic surgical backlog associated with the pandemic was estimated using time series forecasting models on training set (January 2, 2017 to March 11, 2019, 115 weeks), validation set (March 18, 2019
to March 9, 2020, 52 weeks) and forecasting set (March 16, 2020 to December 31, 2020, 42 weeks). Clearance time was calculated based on the queuing theory using various scenarios.

Results: In 2019, Ontario ophthalmologists provided 6.60 million services. In 2020, services were reduced by 22% to 5.13 million. In 2019, 411,823 (6.2%) of ophthalmologist services were procedures/surgeries. This included 203,567 (49%) ophthalmic surgeries that require the use of operating rooms (OR) and 205,945 (50%) anti-VEGF (vascular endothelial growth factor) injections (a common procedure for macular degeneration) and 2,311 (0.6%) pterygium surgeries that can be performed outside of ORs. In 2020, there were 149,146 (27% decrease versus 2019) OR surgeries and 193,921 (6% decrease versus 2019) anti-VEGF injections. From March 16 to December 31, 2020, the estimated ophthalmic surgical backlog requiring ORs was 92,150 surgeries (95% prediction interval [PI] 71,288-112,841), with an average increase of 2,194 surgeries per week. Roughly 90% of the delayed surgeries were cataract surgeries and a concerning 4% were retinal detachment surgeries. Nearly half of the provincial backlog (48%, 44,542/92,150) involved patients from the West health region. Estimated provincial clearance time was 248 weeks (95% confidence interval [CI] 235-260) and 128 weeks (95% CI 121-134) if 10% and 20% of OR surgical capacity per week were added, respectively, based on the weekly ophthalmic surgical volume in 2019. Furthermore, an estimated 23,755 (95% PI 14,656-32,497) anti-VEGF injections were missed. 

Conclusions: The magnitude of ophthalmic surgical backlog in Ontario in 2020 alone raises serious concerns for meeting the ophthalmic surgical needs of patients. As the pandemic continues the accrued backlog size is likely increasing. Planning and actions are needed urgently to manage the collateral impacts of the pandemic on the ophthalmic surgical backlog in Ontario.
 

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