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Author Notes:

Vikas N. O'Reilly-Shah, University of Washington School of Medicine, RR450, 1959 NE Pacific St, Seattle, WA 98195, USA voreill@uw.edu; Cell +1-615-335-3808

All authors meet ICMJE criteria for authorship. V-OS conceived the work, designed data collection tools, monitored data collection, wrote the statistical analysis plan, cleaned and analysed the data, and drafted and revised the manuscript. He is guarantor. VM interpreted the data, and drafted and revised the manuscript. FME interpreted the data and revised the manuscript. JES interpreted the data and revised the manuscript. WVC interpreted the data, and revised the manuscript. DRL analyzed the data, interpreted the data, and revised the manuscript. NJK interpreted the data and revised the manuscript. EH interpreted the data and revised the manuscript. CSJ interpreted the data and revised the manuscript.

I, Vikas O'Reilly-Shah, had full access to all the data in the study and had final responsibility to submit for publication.

All authors declare: no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.


Research Funding:

NIH/NIGMS (T32 GM086270-11, DRL


  • COVID-19
  • pandemic
  • surgical capacity
  • low and middle income countries
  • access
  • anesthesiology calculator mobile application
  • global surgical case volume
  • impact

Real-time assessment of COVID-19 impact on global surgical case volumes.


Journal Title:



Type of Work:

Article | Preprint: Prior to Peer Review


IMPORTANCE: The 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. OBJECTIVE: To 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. DESIGN: Subset of data from an ongoing observational cohort study of users of the application collected from October 1, 2018 to April 18, 2020. SETTING: The mobile application is available from public sources; users download and use the application per their own clinical needs on personal mobile devices. PARTICIPANTS: No 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. RESULTS: 4,300,975 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 RELEVANCE: Application 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.

Copyright information:


This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/).
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