Impact of COVID-19 on Elective Cleft Surgery in Low- and Middle-income Countries

Abstract

Background: The COVID-19 pandemic disrupted health systems worldwide, including in low- and middle-income countries (LMICs). Many countries limited the delivery of elective surgery. To date, COVID-19’s impact on elective surgery in LMICs has been unquantified. We use operative data from a large international non-government cleft organization to compare case volume for 2019 and 2020 to quantify the impact of COVID-19. Methods: Smile Train supports a partner network of over 1100 partners globally to deliver treatment to children with cleft lip and cleft palate (CLP). Treatment data is documented into a proprietary digital platform, Smile Train Express. We compared monthly treatment data for 2019 to 2020, by country, and by World Bank Income group to describe the effect that the COVID-19 pandemic has had on CLP surgery in LMICs. Results: Our analysis shows 25,444 (31.4%) fewer primary operations performed between January and December 2020 than in the same period in 2019 with the most significant decline in procedures observed in April 2020. Many countries resumed elective surgery for CLP procedures from May onward and volume approximated that of pre-pandemic baseline by November of 2020. Conclusions: The emergence of the COVID-19 pandemic had a large impact on health systems and service delivery across the world. We find that this is evident in the delivery of CLP surgery in LMICs. The impact is characterized by a dramatic decrease in surgery rates in April of 2020 with a recovery of surgical volume from July 2020 onwards. The rate of surgical rate recovery is consistent across World Bank Income groups.

Untitled

“…Although there was no significant outcome, the psychological impacts to patients and their families must be considered, especially without knowing when the pandemic would end, and patients under the age of 5 not eligible to receive a COVID-19 vaccine. [5][6][7][8] Other studies, such as the study done by Vander Burg and colleagues (2021) showed that in the period of January to December 2020, the number of cleft repair surgeries declined to as much as 25,444 cases. 6 Patients are predominantly children and added to the number of 60,000 people left with untreated cleft lip palate.…”

“…[5][6][7][8] Other studies, such as the study done by Vander Burg and colleagues (2021) showed that in the period of January to December 2020, the number of cleft repair surgeries declined to as much as 25,444 cases. 6 Patients are predominantly children and added to the number of 60,000 people left with untreated cleft lip palate. January to April 2020 showed the most significant decline in surgeries, while numbers then started to increase over May to December 2020.…”

“…January to April 2020 showed the most significant decline in surgeries, while numbers then started to increase over May to December 2020. 6 Managing cases of postponed cleft lip and palate became challenging for surgeons and hospitals. The psychosocial effects to patients and their families due to this delay requires close monitoring.…”

Adapting Elements of Cleft Care Protocols in Low- and Middle-income Countries During and After COVID-19: A Process-driven Review With Recommendations

“…The pandemic has undoubtedly exacerbated the backlog of healthcare interventions for children born with CL/P, as they are for the most part regarded as planned elective procedures, although the magnitude of these delays on a global scale is yet to be fully appreciated ( Stoehr et al, 2021 ). Projections using data from 67 LMICs estimated 25,000 fewer cleft operations performed during 2020 compared to 2019 ( Vander Burg et al, 2021 ). In Peru, children born with CL/P were having primary reconstructions at a significantly older age during the pandemic when compared to a prepandemic cohort, with delays most marked in primary cleft lip and nose reconstruction ( Rossell-Perry and Gavino-Gutierrez, 2021 ).…”

Impending Backlog of Cleft Palate Patients Due to COVID-19

“…They report that they have over 10,000 patients awaiting treatment [ 3 ]. One recent article using data from Smile Train found that there was a 31% reduction in procedures to correct cleft palate between 2019 and 2020 [ 4 ]. With the arrival of the COVID-19 vaccines, humanitarian organizations should be able to increase the volume of cleft palate procedures performed.…”