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This study examines the impact of COVID\u201019 on pediatric surgical volumes at four LMIC hospitals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective and prospective pediatric surgical data collected at hospitals in Burkina Faso, Ecuador, Nigeria, and Zambia were reviewed from January 2019 to April 2021. Changes in surgical volume were assessed using interrupted time series analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>6078 total operations were assessed. Before the pandemic, overall surgical volume increased by 21 cases\/month (95% CI 14 to 28, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). From March to April 2020, the total surgical volume dropped by 32%, or 110 cases (95% CI \u2212\u2009196 to \u2212\u200924, <jats:italic>p<\/jats:italic>\u2009=\u20090.014). Patients during the pandemic were younger (2.7 vs. 3.3 years, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and healthier (ASA I 69% vs. 66%, <jats:italic>p<\/jats:italic>\u2009=\u20090.003). Additionally, they experienced lower rates of post\u2010operative sepsis (0.3% vs 1.5%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), surgical site infections (1.3% vs 5.8%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), and mortality (1.6% vs 3.1%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>During the COVID\u201019 pandemic, children's surgery in LMIC saw a sharp decline in total surgical volume by a third in the month following March 2020, followed by a slow recovery afterward. Patients were healthier with better post\u2010operative outcomes during the pandemic, implying a widening disparity gap in surgical access and exacerbating challenges in addressing the large unmet burden of pediatric surgical disease in LMICs with a need for immediate mitigation strategies.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-022-06503-2","type":"journal-article","created":{"date-parts":[[2022,3,10]],"date-time":"2022-03-10T14:03:07Z","timestamp":1646920987000},"page":"984-993","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Impact of the COVID\u201019\u00a0Pandemic on Pediatric Surgical Volume in Four Low\u2010 and Middle\u2010Income Country Hospitals: Insights from an Interrupted Time Series 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