Impact of War and COVID-19 on Major Surgery in a Tertiary Hospital in Tigray, Ethiopia: An Interrupted Time-Series Study

Abstract

Objective

To determine the effect of armed conflict and COVID-19 pandemic on the level and trend of surgical volume at Ayder Comprehensive Specialized Hospital, Tigray, Northern Ethiopia.

Methods

All major surgeries carried out over four consecutive years were included and subjected to an interrupted time-series analysis called segmented regression analysis to examine the effect of war and COVID-19 on level of and trend changes in major surgeries. The outcome was measured and estimated that there was a significant change in the number of major surgeries as a result of the conflict and COVID-19 pandemic compared to the baseline status.

Results

We analyzed 29,877 major surgeries conducted during the study period. The results indicate that, before the beginning of the intervention period, on average 632 surgeries per month were performed [632.1 (95% CI: 575.8, 688.41)]. Right after COVID-19, however, this number dropped by 359 patients per month [−359.3 (95% CI: −486.4, −232.2)]. During the war period, the number of surgeries decreased by 232 patients per month [−232.7 (95% CI: −408.5, −56.9)].

Conclusion

This study revealed that both COVID-19 and the war in Tigray have significantly reduced the number of major surgeries that could have been carried out in their absence at a large tertiary hospital in Northern Ethiopia.

Keywords:

• surgery
• trend
• armed conflict
• COVID-19
• Tigray
• war

Data Sharing Statement

The dataset used and/or analysed during the current study is available from the corresponding author on reasonable request.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests.

Additional information

Funding

The authors did not receive any funding for this work.