{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T06:05:28Z","timestamp":1781849128668,"version":"3.54.5"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T00:00:00Z","timestamp":1761696000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Background<\/jats:title>\n In 2020, Covid-19 pushed Swedish health care to its limits regarding access to hospital beds and staffing. A previous investigation of the effects of the first wave of the pandemic in the spring of 2020 revealed a substantial reduction in elective pediatric surgery. The aim of the present study was to expand this analysis on a national and regional level during almost three years with Covid-19.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n For this retrospective cohort study, routine data from all procedures in patients <16 years of age in 2019\u20132022 were extracted from the Swedish Perioperative Register. Data were analyzed according to level of care, type of surgery, procedure code and emergency or elective surgery.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n During 2020\u20132022, the number of surgeries registered was 19,944 fewer than expected as compared to pre-pandemic levels, i.e., a reduction of about 12%. Elective surgery showed a total reduction of 17% while emergency surgery was unaffected. The most dramatic decrease was found in county hospitals where elective surgery was reduced by 28% and the largest effect was found in Ear, Nose, and Throat\/oral surgery (\u221234%). Patient age at the time of surgery did not show any notable differences in total, except for grommets insertion in 2021 and adenoidectomy in 2021 and 2022 compared to 2019.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The Covid-19 pandemic affected the number of surgical procedures in children for more than two years. Future studies of the long-term effects of the large number of canceled operations are warranted.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0335400","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T17:32:58Z","timestamp":1761759178000},"page":"e0335400","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["The Covid-19 pandemic in Sweden: Prolonged and unevenly distributed effects on the volume of pediatric anesthesia and surgery demonstrated by data from the Swedish Perioperative Register"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7299-5414","authenticated-orcid":true,"given":"Sixten","family":"Melander","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunnar","family":"Enlund","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1998-5212","authenticated-orcid":true,"given":"Helene","family":"Engstrand Lilja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Frykholm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,10,29]]},"reference":[{"issue":"1","key":"pone.0335400.ref001","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1111\/apa.16535","article-title":"How Sweden approached the COVID-19 pandemic: Summary and commentary on the National Commission Inquiry","volume":"112","author":"JF Ludvigsson","year":"2023","journal-title":"Acta Paediatr"},{"key":"pone.0335400.ref002","unstructured":"Analys om coronapandemins effekter p\u00e5 v\u00e5rden [Internet]. 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Available from: https:\/\/www.socialstyrelsen.se\/contentassets\/af10f61ee18245dbb1543cd1773002e3\/2022-3-7798.pdf"},{"issue":"1","key":"pone.0335400.ref006","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.arcmed.2021.07.002","article-title":"COVID-19 in Children: Where do we Stand?","volume":"53","author":"GB Nikolopoulou","year":"2022","journal-title":"Arch Med Res"},{"issue":"8","key":"pone.0335400.ref007","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1111\/pan.14203","article-title":"The COVID-19 pandemic first wave in Sweden: A national registry study of the effects on pediatric anesthesia and surgery","volume":"31","author":"S Melander","year":"2021","journal-title":"Paediatr Anaesth"},{"issue":"2","key":"pone.0335400.ref008","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1111\/aas.14174","article-title":"The Swedish Perioperative Register: Description, validation of data mapping and utility","volume":"67","author":"B Holmstr\u00f6m","year":"2023","journal-title":"Acta Anaesthesiol Scand"},{"key":"pone.0335400.ref009","unstructured":"Klassifikation av v\u00e5rd\u00e5tg\u00e4rder (KV\u00c5) [Internet]. Socialstyrelsen. [cited 2022 Dec 5]. Available from: https:\/\/www.socialstyrelsen.se\/statistik-och-data\/klassifikationer-och-koder\/kva\/"},{"key":"pone.0335400.ref010","unstructured":"COVID-19 i svensk intensivv\u00e5rd [Internet]. [cited 2022 Dec 5]. Available from: https:\/\/www.icuregswe.org\/data--resultat\/covid-19-i-svensk-intensivvard\/"},{"key":"pone.0335400.ref011","unstructured":"Statistics Sweden [Internet]. Statistiska Centralbyr\u00e5n. [cited 2022 Dec 5]. Available from: https:\/\/www.scb.se\/en\/Statistics"},{"key":"pone.0335400.ref012","first-page":"104427","article-title":"COVID-19 effects on operating room cancellations at a pediatric tertiary care hospital: A retrospective cohort study","volume":"81","author":"W Jiang","year":"2022","journal-title":"Ann Med Surg (Lond)"},{"issue":"10","key":"pone.0335400.ref013","doi-asserted-by":"crossref","first-page":"3106","DOI":"10.1002\/ppul.25582","article-title":"During the COVID-19 pandemic where has respiratory syncytial virus gone?","volume":"56","author":"G Di Mattia","year":"2021","journal-title":"Pediatr Pulmonol"},{"key":"pone.0335400.ref014","unstructured":"Minskad antibiotikaanv\u00e4ndning under covid-19-pandemin har inte lett till fler allvarliga infektioner. 2020-12-21. Dnr. 5.7-38411\/2020 [cited 2022 Dec 5]. 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Available from: https:\/\/www.folkhalsomyndigheten.se\/nyheter-och-press\/nyhetsarkiv\/2021\/april\/atgarder-mot-covid-19-bakom-stor-minskning-av-smittsamma-sjukdomar\/"},{"issue":"7","key":"pone.0335400.ref016","doi-asserted-by":"crossref","first-page":"2271","DOI":"10.1007\/s00431-021-04015-0","article-title":"The impact of lockdown on pediatric ED visits and hospital admissions during the COVID19 pandemic: a multicenter analysis and review of the literature","volume":"180","author":"MD Kruizinga","year":"2021","journal-title":"Eur J Pediatr"},{"issue":"1","key":"pone.0335400.ref017","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1186\/s12889-023-15375-7","article-title":"Changes in emergency department utilisation in Germany before and during different phases of the COVID-19 pandemic, using data from a national surveillance system up to June 2021","volume":"23","author":"M Schranz","year":"2023","journal-title":"BMC Public 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