Some improvement, but many waits for hip-replacement surgery in N.B. still too long

New Brunswick was much better at meeting target wait times for hip replacements last year than it was in 2020, but some patients continue to experience excruciating delays.

"You just get worn down with it after a while," said Gail Branscombe of Durham Bridge, whose hip is "bone on bone" because of osteoarthritis.

"The chronic pain, it just chips away at you."

According to the latest data from the Canadian Institute for Health Information, 54 per cent of patients in the province who needed hip replacement surgery in 2021 were able to get operations within the six-month benchmark.

That was up from 29 per cent in 2020, but very similar to the rate before the pandemic.

Branscombe has been waiting a year already and was recently told it will be another year before she gets in.

The news didn't come as a surprise, she said, given what she'd already heard about medical delays related to the pandemic, but it still dealt her a psychological blow.

"I had to really do some serious self-talk," she said.

"It's not anger. It's fear of being unable to just look after myself."

"Where will I be before I get this surgery done?"

She thinks it's possible she'll have to start using a wheelchair within six to eight months.

Pain decreases activity

A once active person who enjoyed hiking, running and horseback riding, Branscombe, 67, said her days are now spent much closer to home and revolve around pain management.

"We have a community mailbox. It's such a short little distance, but I have to think about it really hard. Like, is this something I want to do? Because it's going to be very painful. 

"And then it kind of sets me back for a couple of hours later in the day."

Branscombe estimated she's lost about 50 per cent mobility in the last year as she's waited for surgery. 

Getting in and out of a car is "really painful." 

"Sometimes in the morning when I get up and start down the hall, I think, 'Oh, I'm not going to make it because my hip's going to give out'."

She's making increasing use of a cane and trying to be "really cautious" about walking on stairs and other surfaces to avoid a fall.

"You become kind of, 'Well, I might as well just stay home because it's easier'."

One activity she can still manage is swimming, she said, and she finds it very valuable to both her physical and mental health.

"I don't want to go down that rabbit hole of feeling sorry for myself," she said.

"I'm really working hard at that."

Painful future

Branscombe knows she'll likely have another painful wait in her future. Her last X-rays showed she'll probably need the other hip replaced down the road.

Based on what she heard from her doctor's office, the long wait is largely a result of staff and bed shortages at the Dr. Everett Chalmers Hospital.

"There's a lot of complicated things involved," she said, "and a lot of bureaucracy behind it."

"I just think that the health care system is really in shambles."

Canada's health system has a reputation for slow access "unless you're in big trouble," said Andrew MacLean, a medical student and health policy analyst in Fredericton. 

If you have cancer and need radiation therapy, for example, 98 per cent of the time you'll get it within the benchmark 28 days.

For things like hips, knees and cataracts, however, it's deemed people can wait a lot longer and  even those less ambitious targets are often missed.

Two-year waits, such as that faced by Branscombe, are not uncommon, he said.

But it varies between regions and between health authorities. 

The worst of the wait times for benchmark procedures in the province is three years for knee surgery at the Moncton Hospital, he said. Meanwhile a few kilometres away at the Dr. Georges L. Dumont Hospital, it's less than a year.

There's been a discrepancy between Vitalité and Horizon wait times for a while now, said MacLean, and if anything it's getting worse.

He emphasized this has "truly nothing to do with language."

"It has everything to do with how those RHAs are managed and operated."

Long waits harmful, expensive

Long waits do have a significant impact on a person's health, said MacLean.

It becomes difficult to get around. Some people have trouble keeping their weight from increasing, which can then affect their diabetes or their heart.

They may have to pay out of pocket for mobility devices and home renovations.

And it can be difficult on caretakers — partners, spouses, families — to assist somebody who is waiting on a surgical list. 

Branscombe's story is "absolutely heartbreaking," said Dr. Mark MacMillan, president of the New Brunswick Medical Society, acknowledging that surgical delays are a major issue across both health authorities.

He'd like to see the percentage of patients waiting longer than six months for hip replacements "as close to zero as possible."

MacMillan advised those, like Branscombe, who are experiencing long waits to continue to work on their mental health and stay as healthy and physically active as possible.

"We understand your frustration," he said. "It's the same frustration that we as physicians and our nursing colleagues, and other health-care provider colleagues are feeling for you."

"We are doing the best we can to get things moving through as quickly as possible."

There are many underlying issues, he said, the foremost being a shortage of resources — doctors, nurses and funding for operating rooms and hospital beds.

Many provinces have a system that allows a family doctor or specialist to refer their patient to the hospital with the shortest wait time, said MacLean, and New Brunswick "absolutely" should too.

A centralized intake process, he said, would go a long way to bring wait times down, as would more doctors, more operating rooms and available beds for people when they come out of surgery.

Branscombe said she would certainly travel to Miramichi or Upper Waterville for a shorter wait if she had that option.

MacMillan said he doesn't think there's anything to prevent the province from adopting a centralized intake process, "but we can't just snap our fingers" to set it up.

It has to be tested, he said, to make sure it works, is user friendly and gets results.

He doesn't think it would be a "miracle fix" but said it "probably would help reduce the numbers slightly."

"These sort of innovative approaches are what we need."

He noted that self-booking has already started for things such as X-rays.

Change in works

And a pilot project launched at St. Joseph's Hospital in Saint John to speed up orthopedic surgeries "seemed to show benefit." 

Under that pilot, St. Joseph's did inpatient surgeries again for the first time in 21 years, Eileen MacGibbon, Horizon's vice-president of clinical services, explained at the time.

Capacity was added, she said, by running an additional general anesthesia operating room, "repurposing" some beds for patients to stay 24 to 48 hours after surgery and adding "not a huge number" of personnel.

From October 2020 to June 2021, she said, 763 surgeries were done in Saint John, compared to 383 during the same period the previous year.

The number of patients waiting over a year for their hip or knee replacement surgery was cut from almost 200 to 41, she said.

Similar models are still being considered for Moncton and Fredericton, said a Horizon official.

The province has an advisory group on surgeries that is looking at capacity and ways to reduce wait times, Michelle Guenard, a spokesperson for the New Brunswick Health Department, said in an emailed statement,.

There are about 22,000 surgeries in the queue, she said, — 10 per cent more than two years ago.

The latest provincial health plan includes several projects aimed at this, said Guenard.

One is the Enhanced Recovery After Surgery project, which says, by this fiscal quarter, primary care providers are supposed to be able to electronically refer patients to orthopedic specialists "who will get to choose the next available specialist in their zone or can wait for a specific surgeon."

Guenard said the province is also assessing options for use of $2 billion in aid recently announced by the federal government to help clear pandemic backlogs.

For now, in the absence of a centralized system, some information is available to future patients that might help shave off their wait time.

Wait times for various surgical procedures at hospitals across the province are posted on the Health Department's website under the "Patients" tab.

"This information can be used to make informed decisions on where to have a surgery completed," said Guenard.

A patient able to travel to another region for care can ask to be referred to a surgeon in an area where the last reported wait times were shorter.

"The decision needs to be made before the referral is sent to a surgeon for a surgical consult," said Guenard. The surgeon determines where the procedure will be done.