Research Report 2018

A man in an operating room

Dr. David Urbach | Senior Scientist, Surgeon-in-Chief and Medical Director, Perioperative Services

Health policy for a sustainable system

According to Health Quality Ontario, the province’s operating rooms are busy with surgeons performing over 600,000 scheduled operations per year. Wait times for elective surgical procedures are long with a lack of hospital beds causing cancellations or delays in surgical care. By considering surgical procedures like “diseases”, Dr. David Urbach is studying how they are used in certain patient populations, what their health effects are and what value they bring to the healthcare system. Through his research, Dr. Urbach is establishing scientific evidence to inform health policy decisions supporting a sustainable and high-performing healthcare system.

Recently, he led a multi-disciplinary group of physicians, clinicians and researchers to reimagine how total knee joint replacement, one of the most common elective surgical procedures, could be done in an ambulatory – out-patient – setting without compromising safety or successful outcomes for patients. His team was able to take a procedure that on average requires three-day in-patient hospitalization and transformed it to allow patients to go home that same day – often within five hours after surgery. This is done by making changes to how/what anesthesia medication is given, and incorporating the use of digital technology to connect patients to their healthcare team from home. Dr. Urbach estimates that up to 50 per cent of joint replacement patients could be candidates for ambulatory joint replacement which would have significant impact on surgical wait times, costs and results in more appropriate use of in-patient hospital beds, if the new surgical model was implemented across the healthcare system.  

Dr. Urbach is continuing his work to discover new and better ways of providing surgical services and transferring the location of care from the high-resource hospital setting to the community, safely and without compromising outcomes for patients. His research will continue to address access, cost and safety; the three key challenges facing healthcare in Canada today.