J. Bistre-Varon1, T. Wurdeman2,3, L. Nunes Campos2,4, N. S. Kumar2,5, A. Gerk2, T. Dey6, A. Ramos-De La Medina10, F. Vega-Rivera11, S. J. Klug8,9, S. Juran2,8,9, T. Uribe-Leitz2,7,8 1Dorrington Medical Associates, Research, Houston, TX, USA 2Harvard Medical School, Program In Global Surgery And Social Change, Boston, MA, USA 3Loma Linda University Medical Center, Department Of Surgery, Loma Linda, CA, USA 4Universidade de Pernambuco, Faculdade De Ciências Médicas, Recife, PERNAMBUCO, Brazil 5University Of California – San Francisco, East Bay, Department Of Surgery, Oakland, CA, USA 6Brigham and Women’s Hospital, Center For Surgery And Public Health, Department Of Surgery, Boston, MA, USA 7Boston Children’s Hospital, Department Of Plastic Surgery, Boston, MA, USA 8Technical University of Munich, Epidemiology, Department of Sport and Health Sciences, Munich, BAVARIA, Germany 9Technical University of Munich, Munich Data Science Institute (MDSI), Munich, BAVARIA, Germany 10Hospital Español de Veracruz, Department Of Surgery, Veracruz, VERACRUZ, Mexico 11Hospital Angeles Lomas UNAM, Department Of Surgery, Hacienda De Las Palmas, STATE OF MEXICO, Mexico
Introduction:
During COVID-19, the reduced inpatient capacity, nationwide lockdowns, and decreased availability of the surgical workforce led to delayed operations in Mexican hospitals. We sought to illustrate the impact of COVID-19 in the surgical volume in Mexican Ministry of Health (MoH-Secretaria de Salud) hospitals.
Methods:
We conducted a retrospective nationwide analysis of surgical procedures performed in MoH hospitals between 2017 and 2022 using open-source data. We queried all surgical procedures performed in an operating room. Obstetric procedures were excluded due to their essential nature. We examined the monthly number of surgeries and their geographic distribution. Data were compiled from all 32 Mexican states. Procedures were categorized by ICD-9 codes and grouped into four categories: 1. CNS/spine/orthopedics, 2. General/plastic/ vascular/cardiothoracic surgery, 3. Gynecologic/urologic surgery, 4. Head/neck/ophthalmology. We utilized Rstudio to create a procedure-over-time line chart illustrating the change in surgical volume from January 2017 to December 2022 by category, with March 1, 2020 being used to define pre and intra-pandemic cases. For each group, we calculated changes in volume as follows: (covid volume – pre-covid volume)/pre-covid volume.
Results:
In the pre-COVID period, a monthly average of 71,890 operations were performed in Mexico's MoH hospital system. From March 2020 to January 2021, the monthly volume declined (49,937 operations/month), corresponding to a 30.5% decrease in surgical volume. Head/neck/ophthalmology procedures had the highest decline in volume (61.0%), whereas CNS/spine/orthopedics procedures were the least affected category (22.0%). The volume of General/plastic/vascular/cardiothoracic surgeries decreased by 33.0% while Gynecologic/urologic surgeries reduced by 26.9%. Most states followed the overall declining trend of surgical volume, except for Campeche with a 37.2% increase for Head/neck/ophthalmology, and Coahuila, Tabasco, and Baja California where CNS/spine/orthopedics cases increased by 18.0%, 18.0%, and 54.4% respectively.
Conclusion:
There was a significant drop in surgical volume among analyzed surgical specialties, with Head/neck/ophthalmology being the most impacted category while CNS/spine/orthopedics presented the smallest decrease. Our findings support trends seen in other countries. Our study can inform and develop national targeted policies and actionable plans to address the surgical backlog and reduce the related surgical burden of disease.
