Open AccessImpact of the COVID‐19 Pandemic on Pediatric Surgical Volume in Four Low‐ and Middle‐Income Country Hospitals: Insights from an Interrupted Time Series Analysis
Author(s) -
Park Paul,
Laverde Ruth,
Klazura Greg,
Yap Ava,
Bvulani Bruce,
Ki Bertille,
Tapsoba Toussaint W.,
Ameh Emmanuel A.,
Osazuwa Maryrose,
Ugazzi Michele,
Daza José,
Bryce Emma,
Cunningham David,
Ozgediz Doruk
Publication year - 2022
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-022-06503-2
Subject(s) - medicine , pandemic , vascular surgery , cardiac surgery , covid-19 , interrupted time series analysis , abdominal surgery , cardiothoracic surgery , pediatrics , emergency medicine , surgery , disease , infectious disease (medical specialty) , statistics , mathematics
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.