Epidemiology of children and adolescents undergoing surgery at Mexican public hospitals: a retrospective registry-based analysis from 2010 to 2022

INTRODUCTION: Surgical care is essential for addressing acute and chronic conditions in children and adolescents. While national-level data on pediatric surgical procedures in Mexico exist, analysis of such data remain limited. This study aimed to describe geographic variations and temporal trends in pediatric surgical procedures performed at public hospitals from 2010 to 2022, including the impact of the COVID-19 pandemic, and to identify factors associated with in-hospital mortality. METHODS: This retrospective registry-based analysis used hospital discharge data from Mexico's Ministry of Health (MoH) public hospitals (2010-2022), including all elective and emergency surgical procedures in patients aged 0-17. Descriptive statistics summarized demographic and clinical characteristics. Surgical specialties stratified by age and sex were visualized using sankey flow diagrams. Age-standardized incidence rates (ASIR) were calculated per 100,000 children and adolescents by state and year using the WHO world standard population. Interrupted time series (ITS) analysis with Poisson regression evaluated trends of surgical procedure volume. Logistic regression identified factors associated with in-hospital mortality. RESULTS: Among 752,654 pediatric surgical patients, 58.2% were male and 41.8% female. The most common age group was 10-14 years (27.7%). Overall, 42.2% were normal weight, 16.6% of patients were underweight, 21.6% overweight, 19.4% obese. Additionally, 2.1% identified as indigenous. General surgery (46.8%) and orthopedic surgery (23.4%) were the most frequent surgical procedures. The ASIR of surgical procedures was 141.8 per 100,000 children and adolescents nationwide (2010-2022). Guanajuato reported the highest overall ASIR (333.8 per 100,000), while Nuevo León had the lowest (18.5 per 100,000). Surgical procedure volumes increased until 2015, declined thereafter, and dropped sharply by 35.0% in April 2020 at the onset of the nationwide lockdown (exp(β): 0.65, 95% CI: 0.59-0.70), with volumes gradually recovering by 2022. Hospital-acquired infections (HAIs) (aOR: 2.71, 95% CI: 2.46-2.98) and prolonged length of stay (LOS) (aOR: 2.27, 95% CI: 2.13-2.41) were associated with increased in-hospital mortality. CONCLUSION: This national analysis demonstrates pronounced geographic and temporal disparities in pediatric surgical care across Mexico's public hospitals, including substantial declines during the COVID-19 pandemic. Coordinated investments in pediatric surgical infrastructure, state-level health information systems, and referral networks are critical to ensuring equitable, evidence-based pediatric surgical services.