Impact of the COVID-19 Pandemic on Surgical Care in Rwanda: A Multicentre Retrospective Cross-Sectional Study

Abstract

Introduction: The COVID-19 pandemic significantly disrupted global healthcare, with Rwanda reporting 133,078 cases and 1,468 deaths by January 2023. Lockdowns, healthcare worker shortages, and resource reallocation affected surgical care. This study evaluates the impact of COVID-19 and lockdown measures on surgical outpatient consultations, procedural volumes, and inpatient outcomes in Rwanda. Methods: A retrospective, multicentre cross-sectional study was conducted across 22 hospitals, covering university teaching, referral, provincial, district, and private facilities. Data were extracted from hospital records for two periods: pre-pandemic (March 2019–February 2020) and pandemic (March 2020–February 2021). Lockdown phases were classified into country-wide and district-specific restrictions. Primary outcomes included outpatient consultation volumes, surgical procedures, and inpatient metrics (ICU admissions, length of stay, mortality, and transfers). Statistical analysis used general linear models to adjust for confounders. Results: The study included 507,627 surgical outpatients and 68,701 inpatients. While total outpatient consultations increased slightly during the pandemic year (264,114 vs. 243,513 pre-pandemic), consultations dropped by 39% during country-wide lockdowns. The total number of surgical procedures remained stable (34,192 vs. 34,509 pre-pandemic), though emergency surgeries declined. Surgical volumes decreased during district lockdowns but increased slightly during national lockdowns. ICU admissions were lower (0.6% vs. 0.9%), while hospital length of stay remained largely unchanged. Surgical patient mortality decreased from 0.66% to 0.36%, with a decline in interhospital transfers, particularly from district hospitals. Conclusion: Despite pandemic-related disruptions, Rwanda’s surgical service delivery remained resilient, likely due to proactive public health measures and resource management. While lockdowns affected surgical access, overall surgical volumes and patient outcomes were preserved. These findings highlight the importance of strategic planning in maintaining essential surgical care during health crises.