Winnipeg Free Press - PRINT EDITION

Hip and knee replacements face backlog

Concordia forced to slow down

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At a time when Manitobans still face long waits for orthopedic surgery, the province's largest hip and knee replacement program is having to slow down its surgical pace due to operating-room constraints.

Concordia Hospital is on pace to perform 1,650 hip and knee replacements for the fiscal year ending March 31. It was only budgeted to perform 1,500.

The Winnipeg Regional Health Authority, under pressure from the hospital's orthopedic unit, said this week it will fund an additional 64 joint replacements, bringing the total to 1,564. But a WRHA official said that's as far as it's prepared to go for now.

Manitobans continue to suffer some of the longest waits in Canada for orthopedic surgery. A Canadian Institute for Health Information report this spring said Manitoba was meeting the six-month national benchmark wait time for hip replacements only 56 per cent of the time; for knee replacements, the same benchmark time was met just 46 per cent of the time.

Concordia Hospital opened a new state-of-the art orthopedic centre with great fanfare in 2009. Since then, the hospital has been able to perform surgeries more efficiently, increasing its capacity.

"We've speeded up the process. We've gotten better at what we do. We've gotten faster at what we do," a source within the unit said.

Yet earlier this week, the hospital was still wondering whether it would have to perform knee and hip replacements at well below capacity for the remainder of the fiscal year.

The WRHA ponied up the extra money for prosthetics (at about $5,000 per patient) and additional surgeons' fees, but only after it was assured the additional 64 extra surgeries could be performed within the same number of operating-room hours originally earmarked for the program.

Dr. Brock Wright, WRHA senior vice-president, said this week it would be unfair to other surgical disciplines if the orthopedic unit were given more than its allotted share of operating-room time.

"For them to do more than (an additional) 64 (joint replacements) would require them to encroach on (surgical) slates from other services," he said. "And we need those resources elsewhere in the system."

To perform at a pace of 1,650 joint replacements per year through October meant orthopedics was already encroaching on time allocated for general surgery and other surgical specialties, Wright allowed.

But if the surgeons slowed their surgical pace over the next few months, they wouldn't be sitting on their hands, the administrator said, as they would be able to spend more time in the clinic meeting patients. Wait times for initial consultations between patients and specialists are also of concern to the WRHA, Wright said.

Progressive Conservative health critic Cameron Friesen said the province's funding model seems to work against highly efficient surgical centres such as the one at Concordia. And it's unlikely to drive down wait times.

"You've got a system that is not responding to the need (for joint replacements)," he said.

Health Minister Erin Selby was non-committal when asked whether the government needed to expand operating-room space to ensure programs such as the joint-replacement unit at Concordia are operating at capacity.

She chose instead to trumpet Concordia's achievement in becoming more efficient. "We're actually now doing the second most hip and knee surgeries per capita in Canada," she said.

Concordia performs more joint replacements than any other Manitoba hospital. It also does virtually all the high-risk complex surgeries to repair or replace existing implants.

Last year, it did 1,558 hip and knee surgeries, while Grace General Hospital performed 1,476. Both were budgeted to do 1,500 joint replacements this year.

As of Sept. 30, Grace hospital was on pace to do just under 1,500.

Hip and knee replacements are also done at hospitals in Brandon and Winkler, which performed 272 and 309, respectively, last year.

Republished from the Winnipeg Free Press print edition November 23, 2013 A4

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