The COVID-19 pandemic has amplified inefficiencies and lack of access to resources that have stressed Ontario’s healthcare system to the brink. Many Canadians have seen or heard about potential ICU closures, shuttering of emergency rooms, and cancelled elective surgeries.
There is growing concern from both providers and patients about the backlog of postponed surgeries, especially as hospitals struggle with daily operations due to enormous staffing challenges. In Ontario, a large part of the backlog in surgeries consists of patients awaiting hip and knee replacement operations. Ontario performs almost 50,000 hip and knee replacements each year, and the demand for these surgeries continues to rise.
With hospitals understaffed and overloaded with patients who are anxiously awaiting long-delayed surgeries, now is the time to ensure that all our processes are as efficient as possible.
As orthopaedic surgeons and pathologists, we see an opportunity for improvement that can help free up time and limited resources. In Ontario hospitals, there is a routine practice of sending the removed bone during hip and knee replacement surgery for pathology testing. This is based on an outdated practice that pathology testing may reveal a rare cancer that would alter a patient’s treatment plan. But several studies show this testing does not help or change patient care for those undergoing hip and knee surgeries.
In fact, in other provinces, there are major efforts underway to reduce this practice. Manitoba reduced pathology testing for hip and knee surgeries by 93% without negatively impacting patient care.
In Ontario, this routine practice remains entrenched due to many hospital legal department’s interpretation of Regulation 965 of the Public Hospitals Act, which mandates that such tissues removed during an operation be sent together with a short history of the case to a laboratory for examination and report.
Pathology testing requires time and effort from staff including technologists, pathologists’ assistants, and pathologists as well as the use of hazardous chemicals and storage space. It also diverts finite resources from patients who need timely diagnosis, such as those undergoing cancer treatment.
Many groups including Choosing Wisely Canada, in collaboration with the Canadian Orthopaedic Association and the Canadian Arthroplasty Society, have recommended against the routine use of pathological examination for these surgeries. In fact, in July 2019, Choosing Wisely Canada and the Ontario Orthopedic Association sent a joint letter to the Ontario government requesting a simple amendment to the Act to remove the requirement for hip and knee tissues to be sent to the pathology lab for routine testing. Unfortunately, as it currently stands, hospitals that choose to practice according to scientific evidence would be breaking the law.
We are seeing firsthand the cracks in our system unfold that have forced hospitals into crisis mode. Now is the time to find improvements and end redundant practices so Canadians can have timely access to the care they need.
Dr. Sarah Ward, MD, MSc FRCSC, is an orthopaedic surgeon at St. Michael’s Hospital and Assistant Professor in the Department of Surgery at the University of Toronto and Assistant Professor (Cross-Appointment) at the Institute of Health Policy, Management, and Evaluation (IHPME) at the University of Toronto
Dr. Jesse Wolfstadt, MD, MSc, FRCSC, is an orthopaedic surgeon at Mount Sinai Hospital, Assistant Professor in the Department of Surgery at the University of Toronto, and Assistant Professor (Cross-Appointment) at the Institute of Health Policy, Management, and Evaluation (IHPME) at the University of Toronto
Dr. Corwyn Rowsell, MD, FRCPC, FCAP, is a Staff Pathologist at St. Michael’s Hospital and Associate Professor in the Department of Laboratory Medicine at the University of Toronto
This article originally appeared in Toronto Star published on August 25, 2022.