Provincial auditor Bonnie Lysyk says the Regina Qu'Appelle Health Region could not tell her office how much of its capacity is used to provide surgical services.
Lysyk looked at how the health region used its surgical facilities from March 2012 to February 2013.
She says in her annual report that the region hasn't been efficiently using its surgical facilities.
The auditor says that could lead to a loss of public confidence and poor use of public money.
Lysyk is making nine recommendations on how the health region can do better.
The Regina Qu'Appelle Health Region is already lagging behind others when it comes to meeting the Saskatchewan government's goal for surgery wait times.
Health Minister Dustin Duncan said in May that new numbers showed that 90 per cent of surgeries in the province were completed in six months. That's within the third-year target for the government's surgical initiative.
But Regina Qu'Appelle was at 79 per cent.
The Ministry of Health said the health region has made a concerted effort to overcome a shortage of operating room nurses and to expand capacity using private surgery clinics.
The ultimate goal is that by next April all patients will be able to get surgery within three months.
The health region has said it's making progress towards that target but will need more time.