Real-time assessment of COVID-19 impact on global surgical case volumes
Authors: O’Reilly-Shah Vikas N. , Van Cleve Wil , Long Dustin R. , Moll Vanessa , Evans Faye M. , Sunshine Jacob E. , Kassebaum Nicholas J. , Harrison Ewen M , Jabaley Craig S. 
Published: May 2020

AbstractImportanceThe COVID-19 pandemic has disrupted global surgical capacity. The impact of the pandemic in low and middle income countries has the potential to worsen already strained access to surgical care. Timely assessment of surgical volumes in these countries remains challenging.ObjectiveTo determine whether usage data from a globally used anesthesiology calculator mobile application can serve as a proxy for global surgical case volume and contribute to monitoring of the impact of the COVID-19 pandemic, particularly in World Bank low income countries where official data collection is not currently practical.DesignSubset of data from an ongoing observational cohort study of users of the application collected from October 1, 2018 to April 18, 2020.SettingThe mobile application is available from public sources; users download and use the application per their own clinical needs on personal mobile devices.ParticipantsNo user data was excluded from the study.Exposure(s)Events with impacts on surgical case volumes, including weekends, holidays, and the COVID-19 pandemic.Main Outcome(s) and Measure(s)It was previously noted that application usage was decreased on weekends and during winter holidays. We subsequently hypothesized that more detailed analysis would reveal impacts of country-specific or region-specific holidays on the volume of app use.Results4,300,975 data points from 92,878 unique users were analyzed. Physicians and other anesthesia providers comprised 85.8% of the study population. Application use was reduced on holidays and weekends and correlated with fluctuations in surgical volume. The COVID-19 pandemic was associated with substantial reductions in app use globally and regionally. There was strong cross correlation between COVID-19 case count and reductions in app use. By country, there was a median global reduction in app use to 58% of baseline (interquartile range, 46%-75%). Application use in low-income continues to decline but in high-income countries has stabilized.Conclusions and RelevanceApplication usage metadata provides a real-time indicator of surgical volume. This data may be used to identify impacted regions where disruptions to surgical care are disproportionate or prolonged. A dashboard for continuous visualization of these data has been deployed.Key PointsQuestionCan usage data from a globally used anesthesiology calculator mobile application contribute to monitoring of the impacts to global surgical case volume caused by the COVID-19 pandemic, particularly in resource-limited environments such as World Bank low income countries?FindingsIn this ongoing observational cohort study, application usage data from 92,878 unique users in 221 countries was found to serve well as a qualitative proxy for surgical case volume, with clear impacts to app use during weekend, holidays, and during the COVID-19 pandemic.MeaningThis proxy of surgical volume will provide insight into the impact of and recovery from the COVID-19 pandemic where official data collection is not currently practical. A real time dashboard tracking this proxy of global surgical volume is live and under continued development.