Research Article ISSN: 2574 -1241 DOI: 10.26717/BJSTR.2021.35.005727 Impact of COVID-19 on the Number of Surgical Cases at a Tertiary Care Hospital in Karachi, Pakistan Ammara Salam1, Maria Ahmed2, Amara Zafar2*, Sana Shahid2, Maheen Rana2, Ibrahim Zahid2 and Summaya Saeed2 1Fazaia Ruth Pfau Medical College, Pakistan Air Force Hospital, Faisal, Karachi, Pakistan 2Dr Ruth. K.M. Pfau Civil Hospital Karachi, Pakistan *Corresponding author: Amara Zafar, Dr Ruth. K.M. Pfau Civil Hospital Karachi, Pakistan ARTICLE INFO ABSTRACT Received: Objective: Published: April May 19, 06, 2021 2021 performed. The aim of this study was to find out the decline in the number of surgical cases done during this pandemic, and the effect on number of oncological procedures Design: Citation: Ammara S, Maria A, Amara Z, Place and Observational Duration of study. Study: The study was conducted at Dr. Ruth K. M. Pfau Civil aSana Tertiary S, Maheen Care Hospital R, et al., in Impact Karachi, of PakiCOV- HospitalMethodology: Karachi, for ten months from October 2019 till July 2020. ID-19 on the Number of Surgical Cases at - First five months were taken as pre-Covid state (October stan. Biomed J Sci & Tech Res 35(4)-2021. 2019-February 2020) and next five as the Covid state (March 2020- July 2020). Data was BJSTR.Keywords: MS.ID.005727. analyzed using IBM Statistical Package for the Social Sciences (SPSS) version 23.0 and tables were constructed using Microsoft Excel® 2016. Results for quantitative variable COVID-19; Pandemics; Gener- were presented as frequencies and percentages. Independent T test was used to compare Abbreviations: al Surgery the monthly means of pre-Covid and Covid months. The p-value < 0.05 was considered Results: SPSS: Statistical Package significant. for the Social Sciences; COVID-19: Corona- The total number of emergency cases performed in these ten months were virus Disease 2019; PHEIC: Public Health 2190 out of which 1419 (64.8%) cases were performed during pre-Covid state and 771 Emergency of International Concern; (35.2%) cases were performed during Covid state. The total number of elective cases WHO: World Health Organization; SMBB: performed were 3184 out of which 2750 (86.4%) cases were performed during pre- Shaheed Mohtarma Benazir Bhutto; IRB: CovidConclusion: state while 434 (13.6%) cases were performed during Covid state. Institutional Review Board; DUHS: Dow University of Health Sciences; HIMS: Hos- The pandemic has drastically affected the number of surgical cases pital Information Management System; performed in both elective and emergency theatres. In addition to this the number of NHS: National Health Service; PPE: Per- oncological procedures performed have also declined significantly. As surgeons, we need sonal Protective Equipment to devise ways to address this issue and prevent further backlog. Introduction on various sectors of human life and has led to serious socioeconomic Coronavirus Disease 2019 (COVID-19) emerged in the Wuhan and reported deaths, on 30th January 2020, the World Health implications globally [5]. As the number of cases started to rise, city of China in December 2019 [1]. With rising number of cases outnumbering the bed capacity of healthcare facilities, it was to save the healthcare resources and protect healthcare personnel advised to abandon all elective work at the hospitals. This was done Organization (WHO) declared this outbreak as Public Health th March 2020, The American th Emergency of International Concern (PHEIC) [2]. In Pakistan, first from unnecessary exposure. On 13 case of COVID-19 was confirmed on 26 February 2020 in Karachi, healthcare facilities shall review all scheduled elective procedures WHO on 11th College of Surgeons issued a guideline recommending that all Sindh [3]. Soon after which it was declared as a pandemic by the March 2020 [4]. The disease has left negative impacts Copyright@ Amara Zafar | Biomed J Sci & Tech Res | BJSTR. MS.ID.005727. 27826 Volume 35- Issue 4 DOI: 10.26717/BJSTR.2021.35.005727 with a plan to minimize, postpone or cancel them. This was to be Performa was filled out for all participants of the study. Data was done until the healthcare infrastructure was confident to support entered and analyzed using IBM Statistical Package for the Social ® any overwhelming critical patient care needs [6]. Likewise, in Sciences (SPSS) version 23.0 (IBM SPSS Statistics for Windows, Pakistan, all sort of elective work (out-patient clinics and elective Armonk, NY) and tables were constructed using Microsoft Excel procedures) were suspended from the mid of March 2020 as 2016 (Microsoft Corp., Redmond, WA). Results for qualitative Pakistan was also expecting to hit the pandemic peak [2]. The variables were presented as frequencies and percentages. Chi- of healthcare workers and save the human and material resources. main purpose behind this decision was to decrease the exposure square was used to compare the frequencies of pre-Covid and Covid Resultscases. The p-value < 0.05 was considered significant in all cases. Although this proved helpful in combatting the COVID-19 K.M. Pfau Civil Hospital Karachi, which caters thousands of patients emergency, but in the long run it has left a large impact. Dr Ruth (Table 1) shows the demographic characteristics of patients the patients free of cost was also affected. Hundreds of elective presenting during this 10-month period. There were more males every day and offers all sorts of advanced surgical procedures to (71.0%) than females (29.0%) during both pre-covid and covid ± period and there was no significant difference observed. The surgical procedures were cancelled, and cancer surgeries were also mean age of patients was 35.2 16.2 years. The total number of restricted. In order to estimate the difference in the surgical cases emergency cases performed in these ten months (October 2019-July done before the pandemic and during the pandemic, we carefully 2020) were 2190 out of which 1419 (64.8%) cases were performed planned this study. The aim of this study was to find out the decline during Pre-Covid state (October 2019-February 2020) and 771 in the number of surgical cases done during this pandemic, and (35.2%) cases were performed during Covid state (March 2020- the effect of the pandemic on number of oncological procedures July 2020) (Figure 1). The total number of Elective cases performed performed. These numbers are not mere figures but rather were 3184 out of which 2750 (86.4%) cases were performed depiction of the patient suffering. Methodology during Pre-Covid state (October 2019-February 2020) while 434 (13.6%) cases were performed during Covid state (March 2020- Civil Hospital Karachi and Shaheed Mohtarma Benazir Bhutto July 2020) (Figure 2). (Table 1) Demographics (Table 1) depicts the An observational study was conducted at Dr Ruth K.M. Pfau frequencies and percentages of emergency procedures performed study was conducted for a total duration of ten months from before and during the pandemic, highlighting the major procedures (SMBB) Accident Emergency and Trauma Centre, Karachi. The that are performed, which included debridement, appendectomy, laparotomies and incision and drainage procedures. A significant October 2019 till July 2020. Ethical approval to conduct this study difference was observed between exploratory and traumatic was taken from Institutional Review Board (IRB) of Dow University laparotomy and incision and drainage procedure before and during of Health Sciences (DUHS). Cases performed from October 2019 to the pandemic (p<0.05) (Table 2). (Tables 3 & 4) further elaborate the February 2020, were considered as pre-Covid state and from March monthly frequencies and percentages of the emergency surgeries 2020 till July 2020 as Covid state. All surgeries including elective were included. Data was collected from two sources. For elective performed for both pre-Covid and Covid state. It was observed and emergency procedures, conducted during the study period that Exploratory Laparotomy was the most common procedure performed among emergency surgeries (30.6%, n=671) followed surgical procedures, data was collected from Hospital Information by Incision and Drainage (22.7%, n=498), Appendectomy (14.9%, Management System (HIMS) record at the Dowite’s 87 Operation n=326) and Debridement (9.4%, n=205). Traumatic surgeries were Theatre Complex. For emergency procedures, data was collected Table 1. less commonly performed than non-trauma surgeries. from data maintained in HIMS at SMBB Trauma center theatre. A Demographics Pre-COVID COVID P value GenderMale 0.24 Female 995 (70.1%) 559 (72.5%) 424 (29.9%) 212 (27.5%) Age (Mean ± standard deviation)/years 35.2 ± 16.6 35.2 ± 15.4 0.94 Copyright@ Amara Zafar | Biomed J Sci & Tech Res | BJSTR. MS.ID.005727. 27827 Volume 35- Issue 4 DOI: 10.26717/BJSTR.2021.35.005727 Figure 1: Emergency cases during pre-Covid and Covid state. Figure 2: Elective cases during pre-Covid and Covid state. Table 2: Comparison of monthly frequencies of emergency cases during pre-Covid and Covid period. Pre-covid COVID Total p-value 60 205 0.062 145 Debridement 216 110 326 Appendectomy 10.20% 7.80% 9.40% 0.55 15.20% 14.30%273 14.90%671 398 Exploratory laparotomy <0.001* 28.00%355 35.40% 30.60% 143 498 Incision and drainage 75 75 150 0.001* Trauma laparotomy 25.00% 18.50% 22.70% 230 110 <0.001* Other procedures 5.30% 9.70% 6.80% 0.23 340 Note: *p-value<0.05 considered as significant16.20% 14.30% 15.50% Copyright@ Amara Zafar | Biomed J Sci & Tech Res | BJSTR. MS.ID.005727. 27828 Volume 35- Issue 4 DOI: 10.26717/BJSTR.2021.35.005727 Table 3: Monthly frequency of emergency cases during pre-Covid state. PRE-COVID Exploratory Incision and Trauma Month Debridement Appendectomy Other Total laparotomy drainage laparotomy 37 102 55 350 38 104 14 October 25.50% 17.60% 26.10% 28.70%72 18.70%15 23.90% 24.70%302 34 45 88 48 November 23.40%30 20.80% 22.10%65 20.30% 20.00%13 20.90% 21.30% 54 68 39 269 December 37 60 60 January 20.70% 25.00% 16.30% 19.20% 17.30% 17.00% 19.00% 29 78 18 282 20.00%15 17.10% 19.60%63 16.90%53 24.00%15 26.10% 19.90%216 42 28 February Table 4: Monthly frequency10.30% of emergency19.40% cases during15.80% Covid state.