# Inequities in Waiting Times for Major Elective Surgery Before and After the COVID-19 Pandemic: Socioeconomic and Sex Differences in the Southern Barcelona Metropolitan Area

## TL;DR

This study shows that waiting times for major elective surgery decreased after the pandemic, but the benefits were not equally shared across socioeconomic groups.

## Contribution

The study reveals an inverse socioeconomic gradient in post-pandemic waiting times for elective surgery, highlighting hidden inequities.

## Key findings

- Median waiting times decreased after the pandemic for both men and women.
- Lower socioeconomic groups experienced longer waiting times compared to higher groups post-pandemic.
- An inverse socioeconomic gradient was observed in adjusted analyses after the pandemic.

## Abstract

Background: Waiting times for elective surgery are widely used as indicators of health system performance, particularly following the disruption caused by COVID-19. The objective of this study is to compare the waiting times for major elective surgeries in the Southern Barcelona Metropolitan Area before (2018–2019) and after (2022–2023) the pandemic, examining differences according to sociodemographic characteristics. Methods: A retrospective comparative study was conducted using data from the Southern Barcelona Metropolitan Area between 2018 and 2023. Adults registered on the waiting list for major elective surgical procedures were included. All analyses were stratified by sex. A stratified pre–post pandemic analysis was conducted to examine differences in waiting times by Socioeconomic Index. Waiting times were modelled using generalized linear models with a Gamma distribution and log link, adjusting for age and Socioeconomic Index quartiles. Interaction between period and Socioeconomic Index was tested. Results: The analysis included 73,055 individuals (50.5% women). Median waiting time decreased after the COVID-19 pandemic for both sexes (women: 128 to 121 days; men: 99 to 94 days). This reduction showed an inverse socioeconomic gradient. Adjusted analyses showed longer waits in the lowest versus highest Socioeconomic Index quartile after the pandemic (women: RR = 1.23; men: RR = 1.30). Conclusions: Waiting times for major elective surgery decreased after COVID-19. An exclusive focus on waiting time indicators may conceal structural barriers to access and contribute to inequalities. Equity-sensitive monitoring of elective care is essential to ensure a fair recovery of surgical services.