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Background Building capacity for surgical care in low-and-middle-income countries is essential for the improvement of global health and economic growth. This study assesses in-hospital delays of surgical services at Soroti Regional Referral Hospital (SRRH), a tertiary healthcare facility in Soroti, Uganda. Methods A prospective general surgical database at SRRH was analyzed. Data on patient demographics, surgical characteristics, delays of care, and adverse clinical outcomes of patients seen between January 2017 and February 2020 were extracted and analyzed. Patient characteristics and surgical outcomes, for those who experienced delays in care, were compared to those who did not. Results Of the 1160 general surgery patients, 263 (22.3%) experienced at least one delay of care. Deficits in infrastructure, particularly lacking operating theater space, were the greatest contributor to delays (n = 192, 73.0%), followed by shortage of equipment (n = 52, 19.8%) and personnel (n = 37, 14.1%). Male sex was associated with less delays of care (OR 0.63) while undergoing emergency surgeries (OR 1.65) and abdominal surgeries (OR 1.44) were associated with more frequent delays. Delays were associated with more adverse events (10.3% vs. 5.0%), including death (4.2% vs. 1.6%). Emergency surgery, unclean wounds, and comorbidities were independent risk factors of adverse events. Discussion Patients at SRRH face significant delays in surgical care from deficits in infrastructure and lack of capacity for emergency surgery. Delays are associated with increased mortality and other adverse events. Investing in solutions to prevent delays is essential to improving surgical care at SRRH.

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 < 0.01), particularly from lack of operating space (16.9% vs. 46.3%, p < 0.01) and lack of a surgeon (1.6% vs. 4.4%, p < 0.01). Increased proportion of delays in care appear correlated with waves of COVID-19 cases at SRRH. There were no changes in rates of adverse events (5.7% vs. 7.7%, 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.