Abstract
BackgroundThe 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.MethodsRetrospective 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.Results6078 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).ConclusionsDuring 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.
Highlights
On March 11th, 2020, the COVID-19 outbreak was declared a global pandemic by the World Health Organization [1]
This study examines the impact of COVID-19 on pediatric surgical volumes at four low- and middle-income countries (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
Summary
On March 11th, 2020, the COVID-19 outbreak was declared a global pandemic by the World Health Organization [1]. The additional obstacles to surgical care access have resulted in increased backlogs with substantial economic impact [12–14]. These problems are likely further exacerbated in low- and middle-income countries (LMIC), where the proportion of unmet surgical needs is highest [15, 16]. With children making up about half of the population in LMIC, it has been estimated that at least 6000 children likely died every month during the pandemic due to the collateral effects on health systems [17, 18]. 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
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