Patients who get surgery faster show improved health outcomes, experience fewer complications and less stress, have a better quality of life and move on in their health journey sooner. Over the years, governments have set benchmarks for how long Canadians should wait for priority procedures, including cancer treatments, joint replacements and eye surgeries. Waits were getting shorter — until the COVID-19 pandemic overwhelmed hospitals. The lack of beds and staff shortages, combined with public health measures, led to delayed and cancelled surgeries across the country. In 2022, hip and knee replacements and cataract surgeries accounted for nearly 25% of all cancelled or delayed operations.Reference1

This shared health priority has 3 indicators that will measure progress toward shorter waits:

• Annual Change in Surgical Volumes Since Start of COVID-19 Pandemic
• Joint Replacement Wait Times
• Hip Fracture Surgery Within 48 Hours
   

Monitoring how many surgeries are performed each year helps health systems understand their resources and the demand for their services, enabling more effective planning. 

From April 2020 to March 2021 (the first pandemic year), approximately 360,000 fewer surgeries (16%) were performed across Canada than in 2019–2020. In 2021–2022, surgery volumes were lower than pre-pandemic levels by approximately 10% (227,000) because of successive waves of COVID-19 and persistent staff shortages. 

In 2022–2023, surgical volumes returned to pre-pandemic levels with 2.22 million procedures performed, an increase of 0.2% over 2019–2020. 2023–2024 showed further recovery, and volumes (2.33 million) were 5% greater than before the COVID-19 pandemic.

The volume of day surgeries (which do not require a hospital stay) increased 10% in 2023–2024 from 2019–2020, while the volume of planned inpatient surgeries decreased 9% and the volume of unplanned inpatient surgeries increased 3% from 2019–2020. This may reflect an increasing shift from inpatient to day surgery.

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I have had 3 joint replacements within 13 months (1 knee and both hips). Luckily, where I live, they do these surgeries as day surgery, which is what I preferred. Since I didn’t need an overnight admission, I think I was able to get my second hip replacement faster than I otherwise would have — in just 4 months. — Janet Thompson, Patient Partner, Manitoba

Changes in surgical volumes were found to be similar for males and females (increasing 6% and 5%, respectively, in 2023–2024 compared with pre-pandemic volumes). While 1% more surgeries were performed for people who lived in lower-income neighbourhoods in 2023–2024, those who lived in areas with the highest average incomes saw a greater growth in surgeries, at 8% in the same period. Surgeries for adults age 65 and older increased 14% in 2023–2024, while surgeries for other age groups remained below pre-pandemic levels.

The higher volume of surgeries for older adults may also be driven by the change in Canadian demographics. The overall population in 2023 had grown 7% since 2019, with the greatest increase in the age group 65 and older, which had grown 15%.Reference2 This may point to a growing demand for priority procedures in the coming years, including both urgent (hip fractures) and non-urgent (joint replacements) procedures. 

Hip fractures are common (484 per 100,000 people age 65 and older in 2022) and require surgery as soon as possible.Reference3 The benchmark is to get patients their surgical repair within 48 hours. Between April and September 2023, more than 13,000 hip fracture surgeries were performed in Canada, 81% of them within 48 hours — down from 86% in 2019.Reference4

Hip and knee replacements can improve mobility and quality of life and are 2 of the 3 most common inpatient surgeries in Canada.Reference5 Between April and September 2023, more than 66,000 planned hip or knee replacements were done but only 62% (approximately 41,000) fell within the benchmark wait of 26 weeks. The percentage of patients getting surgery within the benchmark varied greatly across the country. 

Fewer joint replacement surgeries were performed within the 26-week benchmark in 2023 (62%) than in 2019 (72%),Reference6 even though more joint replacements were done overall. This may be because patients who had already waited longer than the 26-week benchmark were prioritized for surgery. Additionally, increasing demand for joint replacements, mostly driven by an aging population in Canada, may be contributing to an ongoing backlog. Between April 1 and September 30, 2023, there was a 32% increase in patients age 75 to 84 who received a planned total joint replacement compared with 2019. 

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We are not meeting our preferred wait times despite our best efforts to prioritize them. Periodically, scheduled surgeries get postponed because of a high volume of emergency surgeries, and therefore the scheduled surgery wait-list continues to grow and add inconvenience to all those patients who make plans and work arrangements. — Dr. Michael Bering, Orthopedic Surgeon, Alberta

• Annual Change in Surgical Volumes Since Start of COVID-19 Pandemic, 2019–2020 to 2023–2024 — Data Tables  
• Hip Fracture Surgery Within 48 Hours, 2023–2024 — Data Tables 
• Joint Replacement Wait Times, 2023–2024 — Data Tables 
• Wait times for priority procedures in Canada, 2024
• Surgeries impacted by COVID-19: An update on volumes and wait times