Background: Pediatric surgery in Canada is a limited resource. In Ontario, pediatric hospitals are predominately located in Southern Ontario. This unequal distribution of hospitals may lead to unexpected disparities in child healthcare delivery within the province. Aim and objectives: The primary aim of this study is to determine if living in Northern Ontario results in longer wait times for pediatric surgery compared to patients living in Southern Ontario. Secondary aims include to determine whether age, sex, household income, marginalization, rurality, or care at pediatric hospitals influence wait times. Methods: A retrospective cohort study of pediatric surgeries in Ontario was conducted from January 1st, 2016, to December 31st, 2023. Exclusion criteria included age ≥18 years, date of referral or surgery occurring outside of the study period, or missing data. A generalized estimating equations model with binomial distribution by location of residence was performed with a log link estimate of the relative risk of meeting wait time targets. Secondary analysis was completed using a multivariable Cox proportional hazard ratios and quantile regression modeling. Results: Data from 11 169 961 surgical cases over the 8-year study period were reviewed. 201 719 cases met criteria and were included in the analysis. Overall, 83.3% (168 118/201 719) of pediatric surgical cases in Ontario met wait time targets. Univariable analysis with generalized estimating equations revealed a 0.954 RR, CI 95% 0.946-0.962, p<0.001 for patients in Northern Ontario to meet surgical wait time targets compared to children in Southern Ontario. Multivariable quantile regression modeling revealed that children in Northern Ontario are waiting up to 91 days longer for surgery than those in Southern Ontario. Conclusion: Wait times for pediatric surgery differ between Northern and Southern Ontario patients. Further research is needed to understand the drivers of these differences and impact on clinical outcomes.
Brynn Victoria Margaret Aucoin (Thu,) studied this question.