103. The Impact of COVID-19 restrictions on Open Fracture Emergency Fixation Procedures in eight institutions around South and Southeast Asia

Introduction: Around the time COVID-19 was declared a global pandemic, various restrictions and measures were implemented at all levels to limit disease spread and preserve healthcare capacity. Data is lacking in many low and middle-income countries on how these measures impact healthcare utilization and outcomes. This study aims to determine the impact of COVID-19 restrictions on volumes of the open fracture emergency fixation procedures in South and Southeast Asia. Methods: This was a retrospective cohort study of patients who underwent open fracture fixation from 1 January 2018 to 31 December 2021 at one of 8 institutions in Singapore, Malaysia, Indonesia, India and Vietnam. We compared the weekly volumes, baseline characteristics and outcomes of each procedure across different time periods in each institution defined by different level of COVID-19 restrictions using selected indicators from a city-level and hospital-level response index. Results: A total of 74 (AMH) to 299 (SGH) open fracture fixations were performed over the 4-year period. Weekly volumes decreased significantly at GNRC (p = 1.33 x 10-5), AMH (p = 1.68 x 10-6) and UGH. At UGH there was a drop in the proportion of males during HR1 (66.7%) and HR3 (46.7%) compared to pre-COVID (83.0%) and HR2 (82.4%) (p = 2.02 x 10-4). None of the outcomes were significantly different in any of the institutions. Conclusions: COVID-19 restrictions on the city and hospital level were associated with a decrease in surgical volumes of the open fracture fixation emergency procedures in some of the institutions. There was some suggestion of surgical capacity limitations in UGH and MH175 during periods of more stringent COVID-19 restrictions.