Impact of the COVID-19 Pandemic on Pediatric Surgical Volume in Four Low- and Middle-Income Country Hospitals: Insights from an Interrupted Time Series Analysis
Journal – World Journal of Surgery
Article type – Journal research article – Clinical research
Publication date – Mar – 2022
Authors – Paul Park, Ruth Laverde, Greg Klazura, Ava Yap, Bruce Bvulani, Bertille Ki, Toussaint W. Tapsoba, Emmanuel A. Ameh, Maryrose Osazuwa, Michele Ugazzi, José Daza, Emma Bryce, David Cunningham & Doruk Ozgediz
Keywords – COVID-19 pandemic, Low-and Middle-Income Countries (LMIC), pediatric surgical volumes
Open access – Yes
Speciality – Paediatric surgery
World region Eastern Africa, South America, Southern Africa, Western Africa
Country: Burkina Faso, Ecuador, Nigeria, Zambia
Language – English
Submitted to the One Surgery Index on March 21, 2022 at 4:52 pm
The impact of the COVID-19 pandemic on surgical care delivery in low- and middle-income countries (LMIC) has been challenging to assess due to a lack of data. This study examines the impact of COVID-19 on pediatric surgical volumes at four LMIC hospitals.
Retrospective and prospective pediatric surgical data collected at hospitals in Burkina Faso, Ecuador, Nigeria, and Zambia were reviewed from January 2019 to April 2021. Changes in surgical volume were assessed using interrupted time series analysis.
6078 total operations were assessed. Before the pandemic, overall surgical volume increased by 21 cases/month (95% CI 14 to 28, p < 0.001). From March to April 2020, the total surgical volume dropped by 32%, or 110 cases (95% CI − 196 to − 24, p = 0.014). Patients during the pandemic were younger (2.7 vs. 3.3 years, p < 0.001) and healthier (ASA I 69% vs. 66%, p = 0.003). Additionally, they experienced lower rates of post-operative sepsis (0.3% vs 1.5%, p < 0.001), surgical site infections (1.3% vs 5.8%, p < 0.001), and mortality (1.6% vs 3.1%, p < 0.001).
During the COVID-19 pandemic, children’s surgery in LMIC saw a sharp decline in total surgical volume by a third in the month following March 2020, followed by a slow recovery afterward. Patients were healthier with better post-operative outcomes during the pandemic, implying a widening disparity gap in surgical access and exacerbating challenges in addressing the large unmet burden of pediatric surgical disease in LMICs with a need for immediate mitigation strategies.
OSI Number – 21529