Health of patients on the waiting list: Opportunity to improve health in Canada?

- Access to elective surgery is constrained and cause surgical wait lists.
- Little is known regarding the health of patients waiting for elective surgery.
- Waiting patients report problems with pain, depression and anxiety.
- There is a need for non-surgical interventions while patients wait for elective surgery.
- Policies for accessing elective surgery could incorporate patient health.

IntroductionA number of countries have healthcare systems where access to elective surgery is constrained. The inevitable outcome is wait lists for surgery. The objective of this study is to report cross-sectional health data collected from a broad sample of patients awaiting elective surgery and shed light on potential non-surgical treatments to improve health.Research designProspective cross-sectional survey of patients newly enrolled on the surgical wait list in the Vancouver Coastal Health region. Multivariate regression models were used to estimate the associations between patient characteristics and health, pain and depression.MeasuresHealth status instruments were used to measure study participants' general health, pain, and depression immediately after they were enrolled on the wait list for one of the targeted elective surgeries.ResultsA majority of patients reported some problems with pain or discomfort, and a large portion reported problems associated with anxiety or depression. Orthopedic patients were significantly more likely to report problems with mobility, usual activities and pain/discomfort. Neurosurgery patients were the most likely to report significant and severe depression.ConclusionsThe high rates of pain and depression not only have implications for patients' immediate health, but may also affect long-term surgical outcomes. This study draws attention to recognizing a wider array of morbidity, some potentially requiring non-surgical interventions, while patients wait for elective surgery. Policy options include re-examining the surgical triage system and expanding surgical capacity to match self-reported health.