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Introduction The impact of COVID-19 on low-resource surgical systems is concerning but there are limited studies examining the effect in low- and middle-income countries. This study assesses changes in surgical capacity during the COVID-19 pandemic at Soroti Regional Referral Hospital, a tertiary healthcare facility in Soroti, Uganda. Methods Patients from a prospective general surgery registry at SRRH were divided into cohorts admitted prior to the pandemic (January 2017 to February 2020) and during the pandemic (March 2020 to May 2021). Demographics, pre-hospital characteristics, in-hospital characteristics, provider-reported delays in care, and adverse events were compared between cohorts. Results Of the 1547 general surgery patients, 1159 were admitted prior to the pandemic and 388 were admitted during the pandemic. There was no difference in the median number of elective (24.5 vs. 20.0, p value = 0.16) or emergent (6.0 vs. 6.0, p value = 0.36) surgeries per month. Patients were more likely to have a delay in surgical care during the pandemic (22.6% vs. 46.6%, p p p p = 0.18). Discussion The COVID-19 pandemic caused significant increases in surgical care delays and emergency surgery at SRRH. Strengthening surgical systems when not in crisis and including provisions for safe, timely surgical delivery during epidemic resource allocation is needed to strengthen the overall healthcare system.

Background Surgical disease increasingly contributes to global mortality and morbidity. The Lancet Commission on Global Surgery found that global cost-effectiveness data are lacking for a wide range of essential surgical procedures. This study helps to address this gap by defining the cost-effectiveness of exploratory laparotomies in a regional referral hospital in Uganda. Materials and methods A time-and-motion analysis was utilized to calculate operating theater personnel costs per case. Ward personnel, administrative, medication, and supply costs were recorded and calculated using a microcosting approach. The cost in 2018 US Dollars (USD, $) per disability-adjusted life year (DALY) averted was calculated based on age-specific life expectancies for otherwise fatal cases. Results Data for 103 surgical patients requiring exploratory laparotomy at the Soroti Regional Referral Hospital were collected over 8 mo. The most common cause for laparotomy was small bowel obstruction (32% of total cases). The average cost per patient was $75.50. The postoperative mortality was 11.7%, and 7.8% of patients had complications. The average number of DALYs averted per patient was 18.51. The cost in USD per DALY averted was $4.08. Conclusions This investigation provides evidence that exploratory laparotomy is cost-effective compared with other public health interventions. Relative cost-effectiveness includes a comparison with bed nets for malaria prevention ($6.48-22.04/DALY averted), tuberculosis, tetanus, measles, and polio vaccines ($12.96-25.93/DALY averted), and HIV treatment with multidrug antiretroviral therapy ($453.74-648.20/DALY averted). Given that the total burden of surgically treatable conditions in DALYs is more than that of malaria, tuberculosis, and HIV combined, our findings strengthen the argument for greater investment in primary surgical capacity in low- and middle-income countries.