new research looks at patient outcomes after private surgery at riverside hospital
5 minute read
the ottawa hospital riverside campus.
ashley fraser
/
postmedia
patients who underwent joint replacement surgery at riverside hospital as part of a public-private partnership were no more likely to have negative outcomes than patients who had the same surgery through the ottawa hospital, according to new research.
the research was led by dr. paul beaulé who is medical director of the academic orthopedic surgical associates of ottawa (aoao), the private group of orthopedic surgeons which began performing joint replacement surgeries on weekends at the ottawa hospital’s riverside campus in 2023 using operating rooms which had previously been shuttered.
aoao’s experience running the integrated ambulatory care program at riverside hospital was the subject of a study published in the canadian journal of surgery.
that closely watched pilot effectively served as a trial run for the ontario government’s shift toward private delivery of some surgeries at standalone centres for joint replacement surgery. it is a move critics haves decried as a step toward further weakening an already fragile public health system.
beaulé, who cited “competing interests” (he is the medical director of aoao), concluded that the model is “safe and effective” for improving access for patients requiring joint replacement surgery.
aoao has since been awarded a licence to open one of the first privately run standalone surgical clinics in the province. no opening date has been announced.
aoao also reported that the model helped increase the available health workforce by attracting people back who had left health care for reasons that likely included burnout and workload.
there is international evidence and evidence from across canada that privately run surgical services can reduce wait times, although canadian experiences are mixed. but, according to a 2023 article in the canadian medical association journal, there is also evidence of “unintended consequences” including increases in extra billing and more complex cases in the public system. the article said the way the system is organized can make a difference to results.
advertisement
the plan to shift to more independent, privately operated surgeries in ontario’s health system has drawn criticism and concern from some who fear it will drain scarce health care dollars and limited staff from the public system, while increasing wait times for more complex surgeries that can only be performed at public hospitals. critics also note that operating rooms often sit empty in public hospitals because of the way they are funded and that they could be used to increase surgical volumes and decrease wait times without shifting health dollars to for-profit companies.
the aoao research looked at the outcomes of 234 patients who underwent hip, knee and shoulder replacement surgeries on weekends at riverside hospital run by aoao and the same number who underwent outpatient joint replacement surgery at the ottawa hospital during the same period. the patients were matched with patients of similar age, body mass index and sex. it found no significant differences between the groups when it came to unexpected emergency room visits or postoperative hospital admission or follow up surgery within 90 days.
the study sought to assess the safety, effectiveness and sustainability of the pilot project. out of a total of 600 patients, two could not be discharged on the same day as their procedure because of a sudden drop in blood pressure, in one case, and because of arrhythmia, in another case. both of those patients would have had to be admitted into the public hospital because integrated ambulatory care centres do not have the capacity for overnight care. one patient had to go back into surgery within 90 days because of a prosthetic joint infection and another underwent a further wound procedure in hospital.
the research paper also offered insight into staffing for the surgeries that have been performed at riverside – a key focus of concern.
advertisement
“one concern regarding non publicly run health-care delivery, such as aoao, is that it would add further stress to the canadian health-care workforce, raising questions about the sustainability of such models,” wrote the authors.
aoao employed 46 nurses, half of them full-time and half part-time. it also employed 19 registered practical nurses, 10 of them full-time and 11 other allied health professionals, as well as clerks and supplementary staff.
“our findings suggest that if implemented properly, such a model is an effective way of improving surgical wait-times and patient care in canada while permitting an expansion of the health care workforce.”
more than 65 per cent of staff hired for the weekend surgical clinic came from hospitals other than partner hospital (the ottawa hospital), it said.
the authors noted that wait times for elective surgeries – such as joint replacements – vary greatly across ontario. they called for a coordinated system that matches supply and demand to assist with reducing wait times.
“as stated by the ontario medical association, new models of care must be integrated into canadian health-care systems, leveraging the strong pre-existing hospital system while providing opportunities for increases in efficiencies.”
patients who had surgery through the pilot project at riverside hospital followed the same centralized intake program as all patients in the region. “this ensured equity in terms of access.”
some research from alberta, which has had privately run surgical facilities for decades, tells a different story, especially when it comes to longer term and larger scale reliance on private surgical clinics.
a 2025 study from the parkland institute found that surgeries outsourced to private, for-profit, providers in alberta are significantly more expensive than those performed in public hospitals. the study also found that wait times for many surgeries have increased.
advertisement
the ontario health coalition has raised concerns about the impact of the expansion of private cataract surgeries, with some patients paying thousands of dollars for procedures covered by ohip despite such practices being barred.
the provincial government has included guardrails that prevent clinics from requiring patients to pay for services to get faster care. it also requires clinics to show a plan illustrating that they will not drain staff from public hospitals. surgeries at private clinics are covered by ohip, however the province does allow standalone surgical clinics to offer patient options or upgrades that the patient can choose to pay for. critics call that upselling.
our website is your destination for up-to-the-minute news, so make sure to bookmark our homepage and sign up for our newsletters so we can keep you informed.
share story
