The Azorean healthcare system closed the first quarter of 2026 confronting a familiar and increasingly complex paradox: hospitals performed more surgeries than in the previous year, yet the number of patients waiting for operations continued to rise across the archipelago.

According to the latest report from the Sistema Integrado de Gestão de Inscritos para Cirurgia dos Açores (SIGICA), the Regional Health Service registered 14,913 active surgical proposals between January 1 and March 31, representing a 10.2% increase compared with the same period in 2025.

Behind the numbers lies a healthcare system under growing pressure — one simultaneously expanding surgical activity while struggling to absorb the continuous arrival of new patients into waiting lists.

The report reveals that 3,227 new patients entered surgical waiting lists during the first quarter alone, an increase of 5.8% over the previous year.

The largest rise occurred at the Hospital do Divino Espírito Santo (HDES) in Ponta Delgada, where entries climbed 13.5%, representing 208 additional patients.

The Hospital de Santo Espírito da Ilha Terceira (HSEIT), in Angra do Heroísmo, also recorded growth of 5.6%, while the Hospital da Horta (HH), on Faial Island, was the only hospital to register a decline in new entries, falling 16.1%.

Orthopedics and General Surgery continued to dominate the system both in volume and pressure.

Regionally, Orthopedics led all specialties with 3,748 surgical proposals pending, followed closely by General Surgery with 3,144. Ophthalmology, Otolaryngology, and Vascular Surgery completed the list of the most burdened specialties.

The increases themselves reveal where the healthcare system is feeling the greatest strain.

General Surgery alone registered an additional 349 proposals (+12.5%), while Ophthalmology increased by 252 cases (+13.9%). Plastic and Reconstructive Surgery showed the largest proportional rise, climbing 29.4%.

At HDES, General Surgery, Orthopedics, and Otolaryngology remained the most heavily represented specialties, while Ophthalmology experienced a dramatic 57.8% surge in pending proposals.

Meanwhile, at HSEIT, Orthopedics continued to dominate with 1,036 proposals pending, followed by Ophthalmology and General Surgery.

Across the region, the total number of people officially waiting for surgery rose to 13,465 patients — an increase of nearly 10% compared with the previous year. Nearly 9,000 of those patients were concentrated at HDES alone.

The human dimension of the crisis becomes most visible in waiting times.

By March 2026, the average waiting time for surgery in the Azores had reached 486 days — approximately sixteen months — representing an increase of 30 days compared with 2025.

Some specialties presented particularly severe delays.

Cardiothoracic Surgery registered the longest average wait at 692 days, followed closely by Orthopedics at 686 days. Otolaryngology averaged 569 days, while General Surgery stood at 495 days.

These are not simply administrative delays. They represent years of postponed mobility, prolonged pain, deteriorating quality of life, and mounting emotional fatigue for thousands of patients across the islands.

Yet the report also highlights areas of operational improvement.

During the first quarter of 2026, Azorean hospitals performed 2,282 surgeries — 91 more procedures than during the same period in 2025, representing overall growth of 4.2%.

HDES showed the largest increase, expanding surgical activity by 12.5%, while HSEIT also improved production by 4.7%. Only Hospital da Horta registered a decline, performing 70 fewer surgeries than the previous year.

General Surgery led all specialties in surgical volume with 519 operations performed, followed by Orthopedics with 383 and Ophthalmology with 369.

Orthopedics demonstrated the strongest operational growth, increasing by 27.7% with 83 additional procedures. General Surgery also accelerated significantly, while Otolaryngology expanded surgical activity by over 18%.

Still, the system remains under visible strain.

Surgical cancellations rose 11% regionally, totaling 934 canceled procedures. HSEIT recorded the sharpest increase in cancellations, while Hospital da Horta also experienced significant growth in suspended procedures.

The principal reason remained patient withdrawal or inability to proceed with scheduled surgery — a statistic that often reflects broader realities such as health deterioration during long waiting periods, financial difficulties, transportation barriers between islands, or emotional exhaustion after extended uncertainty.

The report ultimately illustrates the difficult balancing act now confronting the Azorean healthcare system.

The region is simultaneously investing in modernization — including robotic surgery, new infrastructure, and technological upgrades — while continuing to face the persistent structural pressures created by insularity, specialist shortages, demographic aging, geographic fragmentation, and rising demand for care.

The numbers therefore tell two stories at once.

One is a story of hospitals working harder, expanding surgical capacity, and modernizing operations.

The other is a story of a healthcare system whose demand continues growing faster than its ability to respond.

And in island societies, where distance itself shapes access to care, every delayed surgery carries not only medical consequences, but social and human ones as well.

Translated and adapted from a story by journalist Diogo Simões Pires in Correio dos Açores, Natalino Viveiros, director.