Profile of pediatric surgical activity at a referral hospital in Boyacá, Colombia, and the impact of the COVID-19 pandemic: a retrospective study of 3,444 procedures (2016–2021)
This retrospective study of 3,444 pediatric procedures at a Colombian referral hospital (2016–2021) reveals that while the overall surgical volume remained stable during the COVID-19 pandemic, the case mix shifted significantly toward emergency care and older adolescents, with notable decreases in elective congenital and airway procedures and a concurrent increase in appendicitis cases.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
The Great Hospital Shuffle
Imagine a hospital as a giant, bustling kitchen. In this kitchen, the chefs (surgeons) have two types of orders: "Emergency" orders, which are like a fire alarm going off and require an immediate, sizzling response, and "Elective" orders, which are like a reservation for a fancy birthday cake that can be made later if the kitchen gets too busy. Usually, a good kitchen tries to balance these two, making sure the birthday cakes get made while still being ready for the fires.
But what happens when a giant storm hits the city? In the world of medicine, that storm was the COVID-19 pandemic. Scientists have long wondered: when a storm like this hits, does the whole kitchen stop cooking? Do the emergency chefs get overwhelmed, or do they just stop making the birthday cakes? This question is part of a bigger story called "Global Surgery," which asks whether children around the world get the same chance to see a surgeon when they are sick, or if some have to wait while others get help immediately. This story is especially important for places where there aren't many super-specialized hospitals, and every decision about who gets surgery matters a lot.
The Boyacá Story: A Kitchen That Kept Cooking, But Changed the Menu
Now, let's zoom in on a specific kitchen: the Hospital Universitario San Rafael in Boyacá, Colombia. This is a "fourth-level" hospital, which means it's the big boss hospital for the whole region, handling the toughest cases for kids under 18. A team of researchers decided to look back at the last six years of their "recipe book" (from 2016 to 2021) to see how the pandemic storm changed their cooking. They didn't just count the dishes; they looked at what kind of dishes were being made and who was eating them.
They analyzed 3,444 surgeries. Before the pandemic, the kitchen was busy, but the pandemic didn't stop the total number of surgeries from happening. In fact, the average number of surgeries per month stayed almost exactly the same: 48.20 before the storm and 47.00 during it. So, if you just looked at the total number of plates leaving the kitchen, you might think nothing changed. But the researchers found that the menu had completely flipped.
The Great Swap: From Cake to Fire
Before the pandemic, about 63.61% of the surgeries were emergencies (the fires), and 36.39% were elective (the cakes). During the pandemic, the kitchen shifted gears. The number of emergency surgeries jumped to 69.25%, while the fancy, scheduled surgeries dropped to 30.75%. It's as if the chefs stopped baking the birthday cakes to focus entirely on putting out fires. The total work didn't go down, but the type of work changed significantly.
Who Was in the Kitchen?
The storm also changed who was coming through the door. Before the pandemic, the kitchen saw a mix of tiny babies, toddlers, and older kids. But during the pandemic, the crowd got older. The number of teenagers (adolescents) in the surgery line went up from 23.73% to 34.72%, while the number of tiny babies and infants dropped. Why? Because the most common surgery they did was for appendicitis (an inflamed appendix), which is a fire that mostly happens in school-age kids and teenagers. The "cake" surgeries, like fixing birth defects or airway issues in babies, were the ones that got postponed.
The Specific Dishes
When the researchers looked at the specific recipes, they saw some interesting trends:
- The Big Winner: Appendicitis surgeries went up by 21.88%. This was the only major category that got bigger.
- The Big Losers: Surgeries for birth defects (like problems with the face or skull) dropped by 61.32%, and airway surgeries (fixing breathing tubes) dropped by 58.46%. The researchers think the airway surgeries dropped because the pandemic actually stopped the spread of regular colds and flu, so fewer kids needed those fixes. The birth defect surgeries dropped because they are usually scheduled for later and got pushed aside.
- The Mystery: Surgeries for trauma (accidents) and swallowing foreign objects went up, but because the numbers were so small, the researchers couldn't say for sure if this was a real trend or just a fluke.
The Missing Tool
One thing the researchers noticed was a missing tool. Even though this is a top-tier hospital, they didn't do a single laparoscopic (minimally invasive) hernia repair in six years. They did 606 surgeries for hernias and abdominal wall issues, but they all used the old-school, open method. This suggests the hospital might be missing the special equipment or training for the newer, less invasive techniques that are common elsewhere.
The Bottom Line
The pandemic didn't stop the hospital from working; the total volume of surgeries stayed steady. However, it forced the hospital to become a "fire station" rather than a "bakery." They had to prioritize the urgent, non-waitable emergencies, which meant older kids got more attention while the tiniest babies with scheduled needs had to wait longer. The researchers found that while the hospital is resilient, there are gaps in their tools and their data recording (they wrote down diagnoses in free text instead of using a standard code, which made the research harder). This story tells us that in middle-income countries, hospitals are doing their best to keep the lights on, but the storm changes the menu, and sometimes the most vulnerable patients get the short end of the stick.
Drowning in papers in your field?
Get daily digests of the most novel papers matching your research keywords — with technical summaries, in your language.