{"paper_id":"19bbec37-2fe1-4d97-bf41-5f9617bf2943","body_text":"Impact of COVID-19 on Oncologic Surgical Scheduling: A Retrospective Evaluation from 2017 to 2021 in Saltillo, Coahuila, Mexico | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of COVID-19 on Oncologic Surgical Scheduling: A Retrospective Evaluation from 2017 to 2021 in Saltillo, Coahuila, Mexico Pamela Frigerio, Hermes Marco Tulio Alvarado Alvarez, Anahi Carrasco Chavez, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8232043/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: The COVID-19 pandemic has disrupted healthcare systems worldwide, impacting elective and oncologic surgical services. This study evaluates the effect of the pandemic on oncologic surgery scheduling, volume, and outcomes in two major public hospitals in Saltillo, Coahuila, Mexico. Methods: A retrospective, cross-sectional analysis was conducted using data from 2017 to 2021 from the afternoon oncologic surgery schedules of the IMSS General Hospital and the ISSSTE High-Specialty Hospital in Saltillo. Surgical volume, patient demographics, waiting times, and cancellations were analyzed. Oncology surgeries were never suspended during the study period. Results: A total of 1,001 patients underwent surgery (833 IMSS, 168 ISSSTE; 801 women, 200 men). Breast cancer was the most common diagnosis (n = 472). Annual surgical volume decreased markedly during the pandemic (2020: 125; 2021: 120) compared with 2019 (296). Mean waiting times decreased slightly during the pandemic. Only a few surgeries were postponed or canceled, primarily due to patient-related factors. No perioperative COVID-19 infections were recorded. Conclusions: Despite decreased patient volume, oncologic surgeries continued safely during the COVID-19 pandemic. Strict protective measures enabled effective cancer care in hospitals designated for COVID-19, emphasizing the importance of maintaining essential oncology services during public health crises. COVID-19 Oncologic Surgery Surgical Oncology Hospital Scheduling INTRODUCTION Throughout history, humanity has repeatedly faced major health crises that have challenged the resilience of medical systems worldwide. The SARS-CoV-2 pandemic, declared in March 2020 by the World Health Organization, rapidly disrupted global healthcare delivery and forced an unprecedented reorganization of hospital resources and clinical priorities ( 1 ). As healthcare systems became overwhelmed, many institutions suspended elective procedures, including a substantial proportion of surgical services ( 2 , 3 ). However, such widespread interruption was not feasible in oncologic surgery. Delays in cancer treatment have been associated with tumor progression, reduced overall survival, and worse clinical outcomes ( 4 ). Consequently, international surgical and oncologic societies emphasized the necessity of maintaining cancer surgery even in hospitals undergoing conversion to COVID-19 facilities, provided that strict safety protocols were implemented ( 3 , 5 ). Several studies conducted during the early phases of the pandemic demonstrated significant reductions in oncologic surgical volume, varying by region, healthcare capacity, and institutional policies ( 2 , 5 , 6 ). At the same time, reports from specialized centers showed that maintaining oncologic surgery under controlled pathways was both feasible and safe, with minimal or absent perioperative SARS-CoV-2 transmission ( 5 , 6 ). In this context, it is essential to document the experience of centers in which oncologic surgical activity was never suspended, as occurred in the IMSS and ISSSTE hospitals in Saltillo, Coahuila, Mexico. Evaluating surgical scheduling patterns before and during the pandemic provides a clearer understanding of the real impact of COVID-19 on cancer care delivery and offers valuable evidence for planning future health emergencies. OBJECTIVE To describe the surgical scheduling statistics for oncologic procedures before and during the COVID-19 pandemic. MATERIAL AND METHODS This was a retrospective cross-sectional study. Surgical statistics from the afternoon shift of the Surgical Oncology Departments of the Hospital General de Zona No. 1 of the Instituto Mexicano del Seguro Social (IMSS) and the Hospital General de Alta Especialidad of the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), both located in Saltillo, Coahuila, Mexico, were analyzed and compared across the years 2017 to 2021. It is important to emphasize that the scheduled oncologic surgeries in both hospitals were never suspended during the COVID-19 pandemic. All procedures performed during this period were included, and data were obtained from institutional surgical logs and departmental records. The variables collected included the total number of oncologic surgeries performed each year, type of malignancy, patient sex, waiting time prior to surgery, and the number and causes of postponed or canceled procedures. No interventions or modifications to patient management were performed for the purpose of this study. All data were anonymized prior to analysis. Ethical approval was obtained in accordance with institutional and national regulations for research involving human subjects. RESULTS A total of 1001 patients underwent oncologic surgery during the study period. Of these, 833 procedures were performed at the IMSS hospital and 168 at the ISSSTE hospital. The cohort included 801 women and 200 men. Breast cancer was the most frequent diagnosis (n = 472), followed by thyroid tumors (n = 94), ovarian tumors (n = 82), colon cancer (n = 64), rectal cancer (n = 54), sarcomas (n = 28), endometrial tumors (n = 27), gastric cancer (n = 23), parotid tumors (n = 22), pancreatic tumors (n = 18), cervical cancer (n = 16), melanoma (n = 16), primary tumors of unknown origin (n = 12), squamous cell carcinomas (n = 11), retroperitoneal tumors (n = 9), hepatocellular carcinomas (n = 8), basal cell carcinomas (n = 5), vulvar cancer (n = 5), oral cavity tumors (n = 5), small-bowel tumors (n = 4), hyperparathyroidism (n = 4), laryngeal cancer (n = 3), cholangiocarcinoma (n = 3), carotid body tumors (n = 2), gestational trophoblastic disease (n = 1), penile cancer (n = 1), and esophageal cancer (n = 1). Annual surgical volume The total number of surgeries performed each year was as follows: 2017: 192 procedures (177 IMSS; 15 ISSSTE) 2018: 268 procedures (229 IMSS; 39 ISSSTE) 2019: 296 procedures (251 IMSS; 45 ISSSTE) 2020: 125 procedures (87 IMSS; 38 ISSSTE) 2021: 120 procedures (89 IMSS; 31 ISSSTE) A marked decline in the annual surgical volume was observed in 2020 and 2021, coinciding with the COVID-19 pandemic, despite the fact that oncologic surgery services were never officially suspended. Waiting time for surgery (IMSS) Mean surgical waiting times at the IMSS hospital were: 2017: 15.98 days (SD 12.89) 2018: 20.01 days (SD 12.55) 2019: 22.01 days (SD 22.16) 2020: 11.25 days (SD 5.83) 2021: 12.78 days (SD 6.77) A reduction in waiting times was noted during 2020 and 2021, corresponding to the pandemic period. Postponed or canceled surgeries (IMSS) Details of postponed or canceled surgeries at the IMSS hospital were as follows: 2017: 5 cases (2 due to lack of pathologist availability; 2 no-shows; 1 deferred at the request of endocrinology). 2018: 16 cases (3 personal cancellations; 2 uncontrolled medical conditions; 4 upper respiratory tract infections; 1 lack of mammography equipment; 1 lack of leg supports; 1 lack of enemas; 1 inadequate fasting; 1 absence of localization wire; 1 emergency surgery; 1 patient death). 2019: 21 cases (7 no-shows; 4 upper respiratory infections; 3 patient deaths; 2 emergency surgeries; 1 missing medical file; 3 lack of blood donors; 1 lack of pathologist). 2020: 4 cases (1 uncontrolled hypertension; 1 upper respiratory infection; 2 no-shows). 2021: 5 cases (1 operating room unavailability due to emergency; 4 no-shows). COVID-19 infections No preoperative, perioperative, or postoperative SARS-CoV-2 infections were documented among patients in either hospital throughout the study period, despite both institutions being designated as COVID-19 hospitals. DISCUSSION The present study demonstrates a substantial reduction in oncologic surgical volume during the COVID-19 pandemic, despite the fact that scheduled oncologic surgeries were never suspended in either participating hospital. This decline contrasts with the steady increase in procedures observed from 2017 through 2019, suggesting that patient-related factors, rather than institutional policy, contributed most significantly to reduced surgical activity during the pandemic period. Our findings are consistent with international reports indicating a worldwide decrease in elective and oncologic surgical procedures during 2020, largely due to the diversion of healthcare resources, patient fear of infection, and limitations in diagnostic services ( 1 – 3 ). Di Martino et al. reported a notable decline in surgical activity in Spain during 2020, with only 27.8% of procedures performed for malignant disease and a perioperative infection rate of 7% among surgical patients ( 3 ). Their analysis highlighted the vulnerability of cancer patients, noting infection rates as high as 16.9% among oncologic individuals during the early pandemic phase. Although the reduction in surgical volume in our study aligns with their observations, none of our patients developed perioperative SARS-CoV-2 infection, likely reflecting strict protective measures and controlled surgical pathways implemented in our institutions. Similarly, Moriarty et al. described the establishment of a dedicated surgical oncology center in the United Kingdom that successfully treated 1,542 patients during 2020 without COVID-19–related mortality ( 4 ). Their experience parallels our results, as no COVID-19–associated morbidity or mortality was recorded in either participating Mexican hospital. This supports the growing evidence that oncologic surgery can be delivered safely during pandemic conditions when appropriate protocols are enforced. Another relevant comparison is the report by Salzano et al., who observed a 34.5% increase in head and neck oncologic procedures in 2021, attributed to the conversion of other hospitals into COVID-19 centers and the subsequent redirection of oncologic demand ( 5 ). Although our institutions did not experience an increase, this difference likely reflects variations in regional healthcare dynamics. In contrast to European referral centers that absorbed displaced surgical volume, many patients in our region may have postponed seeking medical attention due to fear of contagion, mobility restrictions, or limited access to diagnostic services—factors repeatedly identified in pandemic-related oncology delays ( 2 , 6 , 7 ). An important finding of this study is the reduction in surgical waiting times during 2020 and 2021, despite decreased overall hospital capacity. This is likely a consequence of lower patient demand rather than increased operational efficiency. Additionally, cancellations and postponements decreased markedly during the pandemic years compared with previous years, again reinforcing the reduced number of patients reaching the surgical scheduling process. The absence of perioperative COVID-19 infections in our cohort is particularly noteworthy, especially considering that both hospitals served as COVID-19 facilities. This suggests that implementing dedicated surgical pathways, screening protocols, and strict use of personal protective equipment can effectively mitigate infection risk, even in high-exposure environments—an observation supported by multiple large cohort studies ( 4 , 6 , 7 ). The study’s retrospective design and reliance on institutional records represent inherent limitations. Additionally, the analysis did not assess long-term oncologic outcomes or potential disease progression resulting from delayed diagnosis or treatment. Nonetheless, the five-year comparison offers valuable insight into the real impact of the pandemic on regional cancer surgery in a public healthcare setting where services formally remained active. CONCLUSION In Saltillo, Coahuila, the COVID-19 pandemic was associated with a reduction in oncologic surgical procedures at both IMSS and ISSSTE hospitals. Despite the decrease in patient volume, surgical services were never suspended, and no perioperative COVID-19 infections were recorded. Strict adherence to protective protocols allowed safe management of cancer patients during the pandemic. These findings highlight the importance of maintaining oncology services even in public hospitals designated for COVID-19 care, ensuring timely treatment while minimizing infection risk. Future studies should evaluate the long-term oncologic outcomes related to delayed presentation and reduced surgical volume during the pandemic. Declarations All data used in this study were obtained from institutional surgical records and fully anonymized prior to analysis. No interventions were performed for research purposes. According to institutional and national regulations, the Research Ethics Committee determined that informed consent from patients was not required due to the retrospective nature of the study and the use of de-identified data. Author Contribution All authors contributed equally to the conception, design, data collection, analysis, and interpretation of the study. All authors participated in drafting and revising the manuscript critically for important intellectual content, approved the final version for submission, and agree to be accountable for all aspects of the work. References COVIDSurg Collaborative. Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans. Br J Surg. 2020;107(11):1440–9. Sud A, Torr B, Jones ME, Broggio J, Scott S, Loveday C, et al. Effect of delays in the diagnosis and treatment of cancer: a rapid review. BMJ. 2020;371:m4087. Di Martino M, García Septiem J, Maqueda González R, Muñoz de Nova JL, de la Hoz Rodríguez Á, Correa Bonito A, et al. Elective surgery during the SARS-CoV-2 pandemic (COVID-19): a morbimortality analysis and recommendations on patient prioritisation and safety measures. Cir Esp. 2020;98(9):525–32. Moriarty P, Chang J, Kayani B, Roberts L, Bourke N, Dann C, et al. The development of a surgical oncology center during the COVID-19 pandemic. J Patient Saf. 2021;17(2):81–6. Salzano G, Maglitto F, Guida A, Perri F, Maglione MG, Buonopane S, et al. Surgical oncology of the head and neck during the COVID-19 pandemic. Eur Arch Otorhinolaryngol. 2021;278(8):3107–11. Jazieh AR, Chan SL, Curigliano G, Dickson N, Escalante CP, Grothey A, et al. Delivering cancer care during the COVID-19 pandemic: Recommendations and lessons learned from ASCO global webinars. JCO Glob Oncol. 2020;6:1461–71. Patt D, Gordan L, Diaz M, Okon T, Grady L, Harmison M, et al. Impact of COVID-19 on cancer care: How the pandemic is delaying cancer diagnosis and treatment for American seniors. JCO Clin Cancer Inform. 2020;4:1059–71. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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The SARS-CoV-2 pandemic, declared in March 2020 by the World Health Organization, rapidly disrupted global healthcare delivery and forced an unprecedented reorganization of hospital resources and clinical priorities (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e). As healthcare systems became overwhelmed, many institutions suspended elective procedures, including a substantial proportion of surgical services (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eHowever, such widespread interruption was not feasible in oncologic surgery. Delays in cancer treatment have been associated with tumor progression, reduced overall survival, and worse clinical outcomes (\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e). Consequently, international surgical and oncologic societies emphasized the necessity of maintaining cancer surgery even in hospitals undergoing conversion to COVID-19 facilities, provided that strict safety protocols were implemented (\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eSeveral studies conducted during the early phases of the pandemic demonstrated significant reductions in oncologic surgical volume, varying by region, healthcare capacity, and institutional policies (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e). At the same time, reports from specialized centers showed that maintaining oncologic surgery under controlled pathways was both feasible and safe, with minimal or absent perioperative SARS-CoV-2 transmission (\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eIn this context, it is essential to document the experience of centers in which oncologic surgical activity was never suspended, as occurred in the IMSS and ISSSTE hospitals in Saltillo, Coahuila, Mexico. Evaluating surgical scheduling patterns before and during the pandemic provides a clearer understanding of the real impact of COVID-19 on cancer care delivery and offers valuable evidence for planning future health emergencies.\\u003c/p\\u003e\"},{\"header\":\"OBJECTIVE\",\"content\":\"\\u003cp\\u003eTo describe the surgical scheduling statistics for oncologic procedures before and during the COVID-19 pandemic.\\u003c/p\\u003e\"},{\"header\":\"MATERIAL AND METHODS\",\"content\":\"\\u003cp\\u003eThis was a retrospective cross-sectional study. Surgical statistics from the afternoon shift of the Surgical Oncology Departments of the \\u003cem\\u003eHospital General de Zona No. 1\\u003c/em\\u003e of the Instituto Mexicano del Seguro Social (IMSS) and the \\u003cem\\u003eHospital General de Alta Especialidad\\u003c/em\\u003e of the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), both located in Saltillo, Coahuila, Mexico, were analyzed and compared across the years 2017 to 2021.\\u003c/p\\u003e\\u003cp\\u003eIt is important to emphasize that the scheduled oncologic surgeries in both hospitals were never suspended during the COVID-19 pandemic. All procedures performed during this period were included, and data were obtained from institutional surgical logs and departmental records.\\u003c/p\\u003e\\u003cp\\u003eThe variables collected included the total number of oncologic surgeries performed each year, type of malignancy, patient sex, waiting time prior to surgery, and the number and causes of postponed or canceled procedures.\\u003c/p\\u003e\\u003cp\\u003eNo interventions or modifications to patient management were performed for the purpose of this study. All data were anonymized prior to analysis. Ethical approval was obtained in accordance with institutional and national regulations for research involving human subjects.\\u003c/p\\u003e\"},{\"header\":\"RESULTS\",\"content\":\"\\u003cp\\u003eA total of 1001 patients underwent oncologic surgery during the study period. Of these, 833 procedures were performed at the IMSS hospital and 168 at the ISSSTE hospital. The cohort included 801 women and 200 men. Breast cancer was the most frequent diagnosis (n = 472), followed by thyroid tumors (n = 94), ovarian tumors (n = 82), colon cancer (n = 64), rectal cancer (n = 54), sarcomas (n = 28), endometrial tumors (n = 27), gastric cancer (n = 23), parotid tumors (n = 22), pancreatic tumors (n = 18), cervical cancer (n = 16), melanoma (n = 16), primary tumors of unknown origin (n = 12), squamous cell carcinomas (n = 11), retroperitoneal tumors (n = 9), hepatocellular carcinomas (n = 8), basal cell carcinomas (n = 5), vulvar cancer (n = 5), oral cavity tumors (n = 5), small-bowel tumors (n = 4), hyperparathyroidism (n = 4), laryngeal cancer (n = 3), cholangiocarcinoma (n = 3), carotid body tumors (n = 2), gestational trophoblastic disease (n = 1), penile cancer (n = 1), and esophageal cancer (n = 1).\\u003c/p\\u003e\\n\\u003ch2\\u003eAnnual surgical volume\\u003c/h2\\u003e\\n\\u003cp\\u003eThe total number of surgeries performed each year was as follows:\\u003c/p\\u003e\\n\\u003cul\\u003e\\n \\u003cli\\u003e\\u003cstrong\\u003e2017:\\u003c/strong\\u003e 192 procedures (177 IMSS; 15 ISSSTE)\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cstrong\\u003e2018:\\u003c/strong\\u003e 268 procedures (229 IMSS; 39 ISSSTE)\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cstrong\\u003e2019:\\u003c/strong\\u003e 296 procedures (251 IMSS; 45 ISSSTE)\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cstrong\\u003e2020:\\u003c/strong\\u003e 125 procedures (87 IMSS; 38 ISSSTE)\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cstrong\\u003e2021:\\u003c/strong\\u003e 120 procedures (89 IMSS; 31 ISSSTE)\\u003c/li\\u003e\\n\\u003c/ul\\u003e\\n\\u003cp\\u003eA marked decline in the annual surgical volume was observed in 2020 and 2021, coinciding with the COVID-19 pandemic, despite the fact that oncologic surgery services were never officially suspended.\\u003c/p\\u003e\\n\\u003ch2\\u003eWaiting time for surgery (IMSS)\\u003c/h2\\u003e\\n\\u003cp\\u003eMean surgical waiting times at the IMSS hospital were:\\u003c/p\\u003e\\n\\u003cul class=\\\"decimal_type\\\"\\u003e\\n \\u003cli\\u003e\\u003cstrong\\u003e2017:\\u003c/strong\\u003e 15.98 days (SD 12.89)\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cstrong\\u003e2018:\\u003c/strong\\u003e 20.01 days (SD 12.55)\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cstrong\\u003e2019:\\u003c/strong\\u003e 22.01 days (SD 22.16)\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cstrong\\u003e2020:\\u003c/strong\\u003e 11.25 days (SD 5.83)\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cstrong\\u003e2021:\\u003c/strong\\u003e 12.78 days (SD 6.77)\\u003c/li\\u003e\\n\\u003c/ul\\u003e\\n\\u003cp\\u003eA reduction in waiting times was noted during 2020 and 2021, corresponding to the pandemic period.\\u003c/p\\u003e\\n\\u003ch2\\u003ePostponed or canceled surgeries (IMSS)\\u003c/h2\\u003e\\n\\u003cp\\u003eDetails of postponed or canceled surgeries at the IMSS hospital were as follows:\\u003c/p\\u003e\\n\\u003cul\\u003e\\n \\u003cli\\u003e2017: 5 cases (2 due to lack of pathologist availability; 2 no-shows; 1 deferred at the request of endocrinology).\\u003c/li\\u003e\\n \\u003cli\\u003e2018: 16 cases (3 personal cancellations; 2 uncontrolled medical conditions; 4 upper respiratory tract infections; 1 lack of mammography equipment; 1 lack of leg supports; 1 lack of enemas; 1 inadequate fasting; 1 absence of localization wire; 1 emergency surgery; 1 patient death).\\u003c/li\\u003e\\n \\u003cli\\u003e2019: 21 cases (7 no-shows; 4 upper respiratory infections; 3 patient deaths; 2 emergency surgeries; 1 missing medical file; 3 lack of blood donors; 1 lack of pathologist).\\u003c/li\\u003e\\n \\u003cli\\u003e2020: 4 cases (1 uncontrolled hypertension; 1 upper respiratory infection; 2 no-shows).\\u003c/li\\u003e\\n \\u003cli\\u003e2021: 5 cases (1 operating room unavailability due to emergency; 4 no-shows).\\u003c/li\\u003e\\n\\u003c/ul\\u003e\\n\\u003ch2\\u003eCOVID-19 infections\\u003c/h2\\u003e\\n\\u003cp\\u003eNo preoperative, perioperative, or postoperative SARS-CoV-2 infections were documented among patients in either hospital throughout the study period, despite both institutions being designated as COVID-19 hospitals.\\u003c/p\\u003e\"},{\"header\":\"DISCUSSION\",\"content\":\"\\u003cp\\u003eThe present study demonstrates a substantial reduction in oncologic surgical volume during the COVID-19 pandemic, despite the fact that scheduled oncologic surgeries were never suspended in either participating hospital. This decline contrasts with the steady increase in procedures observed from 2017 through 2019, suggesting that patient-related factors, rather than institutional policy, contributed most significantly to reduced surgical activity during the pandemic period.\\u003c/p\\u003e\\u003cp\\u003eOur findings are consistent with international reports indicating a worldwide decrease in elective and oncologic surgical procedures during 2020, largely due to the diversion of healthcare resources, patient fear of infection, and limitations in diagnostic services (\\u003cspan additionalcitationids=\\\"CR2\\\" citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e). Di Martino et al. reported a notable decline in surgical activity in Spain during 2020, with only 27.8% of procedures performed for malignant disease and a perioperative infection rate of 7% among surgical patients (\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e). Their analysis highlighted the vulnerability of cancer patients, noting infection rates as high as 16.9% among oncologic individuals during the early pandemic phase. Although the reduction in surgical volume in our study aligns with their observations, none of our patients developed perioperative SARS-CoV-2 infection, likely reflecting strict protective measures and controlled surgical pathways implemented in our institutions.\\u003c/p\\u003e\\u003cp\\u003eSimilarly, Moriarty et al. described the establishment of a dedicated surgical oncology center in the United Kingdom that successfully treated 1,542 patients during 2020 without COVID-19\\u0026ndash;related mortality (\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e). Their experience parallels our results, as no COVID-19\\u0026ndash;associated morbidity or mortality was recorded in either participating Mexican hospital. This supports the growing evidence that oncologic surgery can be delivered safely during pandemic conditions when appropriate protocols are enforced.\\u003c/p\\u003e\\u003cp\\u003eAnother relevant comparison is the report by Salzano et al., who observed a 34.5% increase in head and neck oncologic procedures in 2021, attributed to the conversion of other hospitals into COVID-19 centers and the subsequent redirection of oncologic demand (\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e). Although our institutions did not experience an increase, this difference likely reflects variations in regional healthcare dynamics. In contrast to European referral centers that absorbed displaced surgical volume, many patients in our region may have postponed seeking medical attention due to fear of contagion, mobility restrictions, or limited access to diagnostic services\\u0026mdash;factors repeatedly identified in pandemic-related oncology delays (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eAn important finding of this study is the reduction in surgical waiting times during 2020 and 2021, despite decreased overall hospital capacity. This is likely a consequence of lower patient demand rather than increased operational efficiency. Additionally, cancellations and postponements decreased markedly during the pandemic years compared with previous years, again reinforcing the reduced number of patients reaching the surgical scheduling process.\\u003c/p\\u003e\\u003cp\\u003eThe absence of perioperative COVID-19 infections in our cohort is particularly noteworthy, especially considering that both hospitals served as COVID-19 facilities. This suggests that implementing dedicated surgical pathways, screening protocols, and strict use of personal protective equipment can effectively mitigate infection risk, even in high-exposure environments\\u0026mdash;an observation supported by multiple large cohort studies (\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eThe study\\u0026rsquo;s retrospective design and reliance on institutional records represent inherent limitations. Additionally, the analysis did not assess long-term oncologic outcomes or potential disease progression resulting from delayed diagnosis or treatment. Nonetheless, the five-year comparison offers valuable insight into the real impact of the pandemic on regional cancer surgery in a public healthcare setting where services formally remained active.\\u003c/p\\u003e\"},{\"header\":\"CONCLUSION\",\"content\":\"\\u003cp\\u003eIn Saltillo, Coahuila, the COVID-19 pandemic was associated with a reduction in oncologic surgical procedures at both IMSS and ISSSTE hospitals. Despite the decrease in patient volume, surgical services were never suspended, and no perioperative COVID-19 infections were recorded. Strict adherence to protective protocols allowed safe management of cancer patients during the pandemic. These findings highlight the importance of maintaining oncology services even in public hospitals designated for COVID-19 care, ensuring timely treatment while minimizing infection risk. Future studies should evaluate the long-term oncologic outcomes related to delayed presentation and reduced surgical volume during the pandemic.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cspan\\u003eAll data used in this study were obtained from institutional surgical records and fully anonymized prior to analysis. No interventions were performed for research purposes. According to institutional and national regulations, the Research Ethics Committee determined that informed consent from patients was not required due to the retrospective nature of the study and the use of de-identified data.\\u003c/span\\u003e\\u003c/p\\u003e\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003eAll authors contributed equally to the conception, design, data collection, analysis, and interpretation of the study. All authors participated in drafting and revising the manuscript critically for important intellectual content, approved the final version for submission, and agree to be accountable for all aspects of the work.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col start=\\\"1\\\" type=\\\"1\\\"\\u003e\\n \\u003cli\\u003eCOVIDSurg Collaborative. Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans. Br J Surg. 2020;107(11):1440\\u0026ndash;9.\\u003c/li\\u003e\\n \\u003cli\\u003eSud A, Torr B, Jones ME, Broggio J, Scott S, Loveday C, et al. Effect of delays in the diagnosis and treatment of cancer: a rapid review. BMJ. 2020;371:m4087.\\u003c/li\\u003e\\n \\u003cli\\u003eDi Martino M, Garc\\u0026iacute;a Septiem J, Maqueda Gonz\\u0026aacute;lez R, Mu\\u0026ntilde;oz de Nova JL, de la Hoz Rodr\\u0026iacute;guez \\u0026Aacute;, Correa Bonito A, et al. Elective surgery during the SARS-CoV-2 pandemic (COVID-19): a morbimortality analysis and recommendations on patient prioritisation and safety measures. Cir Esp. 2020;98(9):525\\u0026ndash;32.\\u003c/li\\u003e\\n \\u003cli\\u003eMoriarty P, Chang J, Kayani B, Roberts L, Bourke N, Dann C, et al. The development of a surgical oncology center during the COVID-19 pandemic. J Patient Saf. 2021;17(2):81\\u0026ndash;6.\\u003c/li\\u003e\\n \\u003cli\\u003eSalzano G, Maglitto F, Guida A, Perri F, Maglione MG, Buonopane S, et al. Surgical oncology of the head and neck during the COVID-19 pandemic. Eur Arch Otorhinolaryngol. 2021;278(8):3107\\u0026ndash;11.\\u003c/li\\u003e\\n \\u003cli\\u003eJazieh AR, Chan SL, Curigliano G, Dickson N, Escalante CP, Grothey A, et al. Delivering cancer care during the COVID-19 pandemic: Recommendations and lessons learned from ASCO global webinars. JCO Glob Oncol. 2020;6:1461\\u0026ndash;71.\\u003c/li\\u003e\\n \\u003cli\\u003ePatt D, Gordan L, Diaz M, Okon T, Grady L, Harmison M, et al. Impact of COVID-19 on cancer care: How the pandemic is delaying cancer diagnosis and treatment for American seniors. JCO Clin Cancer Inform. 2020;4:1059\\u0026ndash;71.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":false,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":true,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"COVID-19, Oncologic Surgery, Surgical Oncology, Hospital Scheduling\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-8232043/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-8232043/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground:\\u003c/h2\\u003e\\u003cp\\u003eThe COVID-19 pandemic has disrupted healthcare systems worldwide, impacting elective and oncologic surgical services. This study evaluates the effect of the pandemic on oncologic surgery scheduling, volume, and outcomes in two major public hospitals in Saltillo, Coahuila, Mexico.\\u003c/p\\u003e\\u003ch2\\u003eMethods:\\u003c/h2\\u003e\\u003cp\\u003eA retrospective, cross-sectional analysis was conducted using data from 2017 to 2021 from the afternoon oncologic surgery schedules of the IMSS General Hospital and the ISSSTE High-Specialty Hospital in Saltillo. Surgical volume, patient demographics, waiting times, and cancellations were analyzed. Oncology surgeries were never suspended during the study period.\\u003c/p\\u003e\\u003ch2\\u003eResults:\\u003c/h2\\u003e\\u003cp\\u003eA total of 1,001 patients underwent surgery (833 IMSS, 168 ISSSTE; 801 women, 200 men). Breast cancer was the most common diagnosis (n\\u0026thinsp;=\\u0026thinsp;472). Annual surgical volume decreased markedly during the pandemic (2020: 125; 2021: 120) compared with 2019 (296). Mean waiting times decreased slightly during the pandemic. Only a few surgeries were postponed or canceled, primarily due to patient-related factors. No perioperative COVID-19 infections were recorded.\\u003c/p\\u003e\\u003ch2\\u003eConclusions:\\u003c/h2\\u003e\\u003cp\\u003eDespite decreased patient volume, oncologic surgeries continued safely during the COVID-19 pandemic. Strict protective measures enabled effective cancer care in hospitals designated for COVID-19, emphasizing the importance of maintaining essential oncology services during public health crises.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Impact of COVID-19 on Oncologic Surgical Scheduling: A Retrospective Evaluation from 2017 to 2021 in Saltillo, Coahuila, Mexico\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-12-04 11:11:58\",\"doi\":\"10.21203/rs.3.rs-8232043/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"2fedfef1-a076-4826-a267-df21c2d333f7\",\"owner\":[],\"postedDate\":\"December 4th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-12-23T23:53:43+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-12-04 11:11:58\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-8232043\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-8232043\",\"identity\":\"rs-8232043\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}