'Distressing' surgical backlog likely to grow in N.S., says cardiac surgeon

A Nova Scotia surgeon says surgical wait times are likely to grow as physicians are starting to diagnose more patients with diseases that have progressed significantly compared to before the pandemic.

As of Friday, Nova Scotia Health said there were 26,300 Nova Scotians on a wait-list for surgery in the province. 

That's down slightly from an update in March, but Dr. Greg Hirsch says that number does not reflect the real surgical need in the province.

"What's coming to the operating room, what's coming through the emergency room door, and what's coming into acute care beds is more advanced disease than usual," said Hirsch, a cardiac surgeon and the medical director for the preoperative network at Nova Scotia Health.

He said that's in part because patients were reticent to get care, but also because of overcrowded hospitals and a lack of staff.

'People are waiting too long'

Hirsch has been voicing concerns about delaying treatment throughout the COVID-19 pandemic. Now hospitals are seeing the problem first-hand and Hirsch expects surgical wait-lists in some zones to continue growing.

"Yes, I expect broadly, the numbers to go up before they go down," he said.

"People are waiting too long for their procedures. I'll just say it. People are waiting too long for their procedures and that can negatively impact their outcomes. So if they're noticing symptoms are worse, please reach out to surgeon's offices if you're on a wait-list."

Hirsch said while surgical offices are stressed too, they need to know if a patient's condition is worsening and if they need to be placed higher on the wait-list.

"[Surgeons will] turn every stone possible to get you done before disease advances to a point where we can't get the result we hoped to," he said.

Nova Scotia was grappling with long lists before the pandemic. In February 2020, there were 24,500 people waiting for surgeries, according to Nova Scotia Health. 

Some zones worse off than others

Hirsch works in the cardiology department at the QEII Health Sciences Centre in Halifax where the backlog is starting to move. 

Other areas, namely the western health zone, is "significantly worse compared to a month ago," he said.

Issues including a lack of beds and staffing are still causing operations to be pushed back. Hirsch said he's had a few occasions where procedures had to be cancelled minutes before they were scheduled to begin.

"It's brutal for the patient, for the family, and for me," he said.

Those waiting for surgeries are often told to look at the provincial wait-time website, which gives time estimates by procedure and physician.

But as of Friday, that information had not been updated since March, and does not include the new delays caused when Omicron hit its peak in April.

Surgeons 'distressed,' says Hirsch

Hirsch has a handwritten list of his patients in need of heart surgery sitting on his desk. He said he has no idea when he'll be able to treat those beyond the top five names.

It might be soon, he said, or it could be longer than expected. He said he's as in the dark as his patients.

"The surgeons I know are distressed and want to do a better job and don't know what to do. Kind of the same way the patients don't," he said.

While his words may sound bleak, Hirsch said he does have some optimism. He said for the first time in his career, everyone involved with the health-care system is on the same page and motivated to get things moving.

"We have worked very hard to do any kind of operation that you can do that doesn't require a bed, and to expand the number of procedures we're willing to try to do without a bed to back you up," he said.

More staff are being trained to help those who are overworked, but he acknowledges that bringing on new people takes time. 

"Everybody is poised and the money is there," he said of the drive to work through the backlog.

"I've never seen this much alignment between government, senior leadership and front-line folks. We want to provide this care."