Article Figures & Tables
Figures
- Figure 1:
Model schematic depicting patient flow for cases requiring subspecialty ophthalmic surgery. Two entry streams for patients include urgent cases and surgical wait-list (consists of existing wait-list before the pandemic and daily additions following declaration of the pandemic). The stop node (red symbol) represents resource constraint for ophthalmic subspecialty surgery. For patients in semiurgent and nonurgent classifications, there is a deterioration and increase in urgency priority (as indicated by the dashed line) for surgery as the maximum wait time is reached (highest priority given to “Level 1”). This was done to account for the risk of vision impairment associated with delays in surgical repair. Patients move to the “Outcomes” health states after surgery only when resources become available. Those requiring additional surgical interventions will re-enter the model (as indicated by the dotted line). Note: P1–4 = priority level 1–4.
- Figure 2:
Monthly surgical throughputs based on real data after the pandemic began (solid blue line = 2020; solid green line = 2021) compared with 2019 (solid grey line). The dotted line shows the model-estimated monthly increase in number of surgeries required to clear the backlog created as a result of COVID-19 over a 2-year period starting in September 2021 (recovery plan A). The dashed line shows the monthly increase in number of surgeries required to clear the backlog over a 1-year period starting in September 2021 (recovery plan B). These recovery plan results show the degree of escalation in resource availability required to return to the prepandemic wait-list queue and wait times for ophthalmic surgery. Note that only the first months of the recovery plans are depicted in the graph.
- Figure 3:
Monthly model-estimated accumulation of patients awaiting surgery for all ophthalmic surgeries and subspecialty types, including cataract surgery (A, cataract and combination cataract and other procedures), retina surgery (B, vitrectomy and other vitreoretinal surgery), corneal surgery (C, corneal transplant and other cornea surgery), glaucoma surgery (D, glaucoma filter or seton and other glaucoma surgeries), oculoplastics (E) and adult strabismus surgery (F) from March 2020 to March 2023. The simulations were run 50 times (variations in projected estimated represented by lighter blue lines) for a total of 240 000 patients. Note that the y-axis scale for cataract surgery (A) is different than that of the other subspecialty groups.
Tables
- Table 1:
Monthly real-data wait-list queue, wait time, newly added cases and cases completed for ophthalmic surgery in Ontario from January 2019 to February 2020, by subspecialty and priority level*
Variable No. or mean ± SD All subspecialties Cataract Retina Glaucoma Cornea Oculoplastics Strabismus Patients waiting for surgery All urgency levels† 58 380 54 030 1154 592 833 1247 524 Semiurgent (P2–3)‡ 4688 3983 364 190 45 66 38 Nonurgent (P4)§ 53 692 50 047 789 402 788 1181 486 Wait time, d, mean ± SD All urgency levels† 89.6 ± 95.9 93.1 ± 97.5 37.8 ± 58.9 52.0 ± 60.9 92.7 ± 93.5 73.2 ± 65.8 109.3 ± 101.3 Semiurgent (P2–3)‡ 62.8 ± 92.8 80.6 ± 103.2 23.6 ± 46.0 30.6 ± 35.8) 37.6 ± 43.8 31.2 ± 33.6 84.6 ± 145.4 Nonurgent (P4)§ 92.6 ± 95.8 94.1 ± 96.9 51.6 ± 64.3 67.5 ± 70.3 98.6 ± 95.8 79.9 ± 67.2 109.1 ± 88.5 Cases added per month All urgency levels† 14 176 12 697 671 230 179 279 115 Semiurgent (P2–3)‡ 1657 1155 330 100 24 36 9 Nonurgent (P4)§ 12 520 11 542 341 130 155 243 106 Cases completed per month All urgency levels† 13 661 12 271 631 220 170 254 109 Semiurgent (P2–3)‡ 1390 923 312 91 17 34 9 Nonurgent (P4)§ 12 271 11 348 319 129 153 220 100 Note: P2–4 = priority level 2–4, SD = standard deviation.
↵* Data source: Wait Times Information System, Ontario Health.
↵† Includes semiurgent and nonurgent cases. Urgent cases are not included as they are not adequately documented through Ontario Health.
↵‡ Moderate probability of disease progression. Low probability of disease occurrence or progression affecting morbidity or mortality.
↵§ Minimal risk of disease progression affecting morbidity or mortality.
- Table 2:
Wait times for patients awaiting semiurgent and nonurgent ophthalmic subspecialty surgery for November 2019 and November 2020
Variable Wait time, d, mean ± SD All subspecialties Cataract Retina Glaucoma Cornea Oculoplastics Strabismus Real data* November 2019 94.4 ± 97.4 94.4 ± 99.1 37.7 ± 44.7 48.6 ± 49.8 96.4 ± 95.9 77.2 ± 70.2 102.1 ± 94.4 November 2020 101.9 ± 137.2 126.9 ± 135.7 47.9 ± 80.6 51.8 ± 78.9 109.6 ± 114.2 111.3 ± 126.0 201.2 ± 190.7 Projected model estimates† November 2020 to March 2021 198.5 ± 81.4 177.0 ± 101.5 110.9 ± 68.3 187.8 ± 67.6 229.8 ± 78.3 186.6 ± 99.4 298.9 ± 64.8 April 2021 to March 2022 220.9 ± 116.1 225.7 ± 115.0 121.1 ± 69.4 206.4 ± 63.8 278.8 ± 79.6 232.5 ± 114.2 526.0 ± 90.8 April 2022 to March 2023 282.1 ± 91.4 244.8 ± 121.2 124.2 ± 69.3 211.2 ± 61.6 298.8 ± 81.6 250.9 ± 120.1 562.5 ± 75.6
In this issue
Article tools
