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

Abstract

Background 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. Methods 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. Results 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). Conclusions 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.

The impact of the COVID-19 pandemic on paediatric surgical volumes in Africa: A retrospective observational study

“…Every age group experienced a decrease in total procedures performed except the neonatal group who actually experienced an increase during this time. This phenomenon has been noted in prior analyses [4] and is thought to reflect a decision to prioritise neonates who are already in hospital. Decreases in caseload for older age groups may reflect reduced care seeking and reduced access to hospital as a result of travel restrictions and reluctance to leave home.…”

“…The unintended collateral effects on surgical services provision in HICs are well worn in the surgical literature and paint a picture of a transient disruption [3] . The experience of low-and middle-income countries (LMICs) however is not as well characterised [4] . There is a dearth of work describing the effect of COVID-19 on children's surgery in LMICs and Africa has been conspicuous in its absence from published work on paediatric surgery during the pandemic including an early global review on this subject [5] .…”

Pediatric Surgical Waitlist in LMICs during the COVID-19 Pandemic

“…The ITSA demonstrated the persistent effects of the pandemic and provided evidence that the collateral damage of the pandemic on health services extended to children's surgery. [21] Unfortunately, this damage also affected other areas of child health and development. COVID-19 created the largest disruption of education systems in history, affecting nearly 1.6 billion students in more than 190 countries.…”

Infecciones Postquirurgicas De Heridas en Miembros Inferiores en Pacientes Adultos Atendidos en Un Hospital General De Quito-Ecuador.

“…Asimismo, en el estudio realizado por Romero y Placencia (25), en la ciudad de Babahoyo, en el año 2015, la población osciló en el rango de 16 a 80 años, con un promedio de 39 años, mientras que en la investigación realizada por Aguirre Barillas (26), en donde se estudió la analizar la relación entre la presencia de las condiciones consideradas factores de riesgo para evisceración y la aparición de dicha complicación en los pacientes sometidos a laparotomía en el servicio de cirugía general de un hospital de Managua, en el año 2017, la población estuvo en el rango de 21 a 77 años, con una media de 41,5 años. Recientemente en países como Ecuador el impacto de la pandemia de COVID-19 en la prestación de atención quirúrgica en países de ingresos bajos y medios ha sido difícil de evaluar debido a la falta de datos y a medida que los sistemas de atención médica clasificaron y buscaron recursos durante las oleadas, muchas actividades quirúrgicas en diferentes subespecialidades se consideraron no esenciales y se suspendieron o cancelaron (27).…”

“…Favorablemente la mayoría de las heridas quirúrgicas no presentaron infecciones y entre las que las presentaron, fueron infecciones de la superficie de la incisión, con un 94,4%. Esto sugiere el cumplimiento de los protocolos de preparación de pacientes prequirúrgicos y de seguridad en la cirugía (27). No obstante, se destaca y en concordancia con lo reportado por Rodziewicz y col. (28) y Gebrim y col. (29) estudios como el presente, indican la necesidad de revisión del modelo de gestión y más inversión en el cumplimiento de indicadores, como parte de un sistema organizativo, en favor de una cultura de calidad y seguridad en la atención al paciente quirúrgico.…”