Predicting the Ophthalmic Surgical Backlog as a Result of the COVID-19 Pandemic: A population-based study and microsimulation model to inform surgical recovery plans

Felfeli, T.; Ximenes, R.; Naimark, D. M.; Hooper, P. L.; Campbell, R. J.; El-Defrawy, S. R.; Sander, B.

Background: Jurisdictions worldwide ramped down ophthalmic surgeries to mitigate the effects of coronavirus disease 2019 (COVID-19), creating a global surgical backlog. We sought to predict the long-term impact of COVID-19 on ophthalmology surgical care delivery. Methods: This is a population-based study and a microsimulation model for predicting future outcomes. Provincial administrative data from January 2019 to November 2020 was used to estimate the decline in surgical volumes during the COVID-19 pandemic. For the post-pandemic recovery phase, we estimated the resources required to clear the backlog of patients accumulated on the waitlist since the pandemic. Results: A total of 56,923 patients were on the waitlist in the province of Ontario awaiting non-emergency ophthalmic surgery as of March 15, 2020. The number of non-emergency surgeries performed in the province decreased by 45-98% between March to May 2020 compared to the same months in 2019. By 2 years and 3 years, the overall estimated number of patients awaiting surgery grew by 125% and 148%, respectively. The mean wait time for patients for all subspecialty surgeries increased to 198.49 days (SD 81.38) in March 2021 compared to 94.41 days (SD 97.42) in 2019. The provincial monthly additional resources required to clear the backlog by March 2023 was estimated to be 126% (3,538 additional surgeries). Discussion: The magnitude of the ophthalmic surgical backlog from COVID-19 has important implications for the recovery phase. The estimates from the surgical database and microsimulation modelling can be adapted to other jurisdictions to assist with recovery planning.