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

Objective: To determine the effect of armed conflict and COVID-19 pandemic on the level and trend of surgical volume at Ayder 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.