Background Many organizations have issued recommendations to limit elective surgery during the coronavirus disease 2019 (COVID-19) pandemic. We surveyed providers of children’s surgical care working in low-income and middle-income countries (LMICs) to understand their perspectives on surgical management in the wake of the COVID-19 pandemic and how they were subsequently modifying their surgical care practices. Methods A survey of children’s surgery providers in LMICs was performed. Respondents reported how their perioperative practice had changed in response to COVID-19. They were also presented with 26 specific procedures and asked which of these procedures they were allowed to perform and which they felt they should be allowed to perform. Changes in surgical practice reported by respondents were analyzed thematically. Results A total of 132 responses were obtained from 120 unique institutions across 30 LMICs. 117/120 institutions (97.5%) had issued formal guidance on delaying or limiting elective children’s surgical procedures. Facilities in LICs were less likely to have issued guidance on elective surgery compared with middle-income facilities (82% in LICs vs 99% in lower middle-income countries and 100% in upper middle-income countries, p=0.036). Although 122 (97%) providers believed cases should be limited during a global pandemic, there was no procedure where more than 61% of providers agreed cases should be delayed or canceled. Conclusions There is little consensus on which procedures should be limited or delayed among LMIC providers. Expansion of testing capacity and local, context-specific guidelines may be a better strategy than international consensus, given the disparities in availability of preoperative testing and the lack of consensus towards which procedures should be delayed.

中文翻译：

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低收入和中等收入国家 COVID-19 大流行期间儿童手术状况围手术期管理的观点：一项全球调查


背景 许多组织已发布建议，限制 2019 年冠状病毒病 (COVID-19) 大流行期间的择期手术。我们对低收入和中等收入国家 (LMIC) 的儿童外科护理提供者进行了调查，以了解他们在 COVID-19 大流行后对外科管理的看法以及他们随后如何修改外科护理实践。方法 对中低收入国家的儿童手术提供者进行了调查。受访者报告了他们的围手术期实践如何因应对 COVID-19 而发生变化。他们还收到了 26 个具体程序，并询问他们被允许执行哪些程序以及他们认为应该被允许执行哪些程序。对受访者报告的外科实践的变化进行了主题分析。结果 30 个中低收入国家的 120 个独特机构总共收到了 132 份回复。 117/120 个机构（97.5%）已发布关于延迟或限制选择性儿童外科手术的正式指南。与中等收入机构相比，低收入国家的机构发布择期手术指南的可能性较小（低收入国家为 82%，中低收入国家为 99%，中高收入国家为 100%，p=0.036）。尽管 122 家 (97%) 提供者认为在全球大流行期间应限制病例数，但没有任何程序可以让超过 61% 的提供者同意推迟或取消病例。结论 中低收入国家医疗服务提供者对于应限制或延迟哪些程序几乎没有达成共识。 鉴于术前检测的可用性存在差异，并且对于应推迟哪些手术缺乏共识，扩大检测能力和针对具体情况的当地指南可能是比国际共识更好的策略。