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

ABSTRACT

Purpose: Health systems' responses to the coronavirus disease 2019 (COVID-19) pandemic created a surgical backlog of unknown size, limiting 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. 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 (115 weeks), validation set (52 weeks) and forecasting set (42 weeks). Clearance time was calculated based on the queuing theory using various scenarios. Results: In 2020, there were 5.13 million ophthalmologist services, a reduction of 22% compared to the 6.60 million services in 2019. This included a 27% decrease in ophthalmic surgeries that require the use of operating rooms (OR) and a 6% decrease in anti-VEGF (vascular endothelial growth factor) injections (a common procedure for macular degeneration) that can be done in clinics. From March 16 to December 31, 2020 (a pandemic period), the estimated backlog in ophthalmic surgeries requiring an OR was 92,150 surgeries (95% prediction interval [PI] 71,288-112,841), increasing on average by 2,194 surgeries per week. Roughly 90% of the delayed surgeries were cataract surgeries and 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 impact of the pandemic on the ophthalmic surgical backlog in Ontario.