Impact of COVID-19 restrictions on emergency bellwether procedures in South and Southeast Asia

Around the time COVID-19 was declared a global pandemic, various restrictions and measures were implemented at all levels to limit disease spread and preserve healthcare capacity. Data are lacking in many low- and middle-income countries on how these measures impact healthcare utilisation and outcomes. This study aims to determine the impact of COVID-19 restrictions on volumes of the three emergency bellwether procedures in South and Southeast Asia.

This was an interrupted time series study of patients who underwent any of the three emergency bellwether procedures (caesarean section, laparotomy and open fracture fixation) from 1 January 2018 to 31 December 2021 at one of eight institutions in Singapore, Malaysia, Indonesia, India and Vietnam. We compared the weekly volumes, baseline characteristics and outcomes of each procedure across different time periods in each institution defined by different levels of COVID-19 restrictions using selected indicators from a city-level and hospital-level response index.

Weekly volumes of emergency caesarean section decreased significantly in Guwahati Neurological Research Centre (GNRC) (p=1.62×10^-5) and Ulin General Hospital (UGH) (p<2.2×10^-16) but increased in Adam Malik Hospital (AMH) (p=1.45×10^-5). For laparotomies, volume increased in Singapore General Hospital (p=2.38×10^-5) but decreased in Military Hospital 175 (p=6.30×10^-7). The volume of open fracture fixations decreased in GNRC (p=3.08×10^-8), AMH (p=1.68×10^-6) and UGH (p=8.15×10^-6).

COVID-19 restrictions on the city and hospital level were associated with a decrease in surgical volumes of the three bellwether procedures in some of the institutions. There was some suggestion of surgical capacity limitations in UGH and Military Hospital 175 during periods of more stringent COVID-19 restrictions.