Understanding the Effect of COVID-19 Pandemic on Emergency Surgical Care Delivery in India: A Multicenter Cross-sectional Study

Background: The COVID-19 pandemic and subsequent lockdowns adversely affected global health care services to varying extent. Emergency Services were affected along-with elective surgeries, to accommodate the added burden of COVID19 affected patients. We aimed to reflect, quantify and analyse the trends of essential surgeries and bellwether procedures during the waxing and waning of the pandemic, across various hospitals in India. Method: ology A research consortium led by WHO Collaboration Centre (WHOCC) for Research in Surgical Care Delivery in Low-and Middle-Income countries, India, conducted this study with 5 centres. All surgeries performed during the months of April 2020 (wave 1), November 2020 (recovery 1) and April 2021 (wave 2) were compared with those performed in April 2019 (pre-pandemic period). Results: The total number of surgeries reduced by 77% during wave 1, which improved to 52% reduction in recovery 1, as compared to pre-pandemic period. However, surgeries reduced again during wave 2 to 68%, but reduction was less as compared to wave 1. Emergency and essential surgeries were affected along-with the elective ones, but to a lesser extent. Conclusion: Our study quantified the effects of the pandemic on surgical-care delivery across a timeline and documented reduction in overall surgical volumes during the peaks of the pandemic (wave 1 and 2) with minimal improvement as the surge of COVID19 cases declined (recovery 1). The second wave showed improved surgical volumes as compared to the first one which may be attributable to improved preparedness. Caesarean sections were affected the least.