Profile of pediatric surgical activity at a referral hospital in Boyacá, Colombia, and the impact of the COVID-19 pandemic: a retrospective study of 3,444 procedures (2016–2021)

<title>Abstract</title> <p>Purpose. To describe the profile of pediatric surgical activity at a fourth-level referral hospital in Boyacá, Colombia, and to assess whether the COVID-19 pandemic altered its volume and case-mix. Methods. Retrospective observational study (STROBE) of all 3,444 procedures performed in patients under 18 years between January 2016 and December 2021. Recorded diagnoses were assigned to mutually exclusive clinical categories. The pandemic period was defined from March 1, 2020. Proportions between periods were compared with the χ² test and monthly volumes with the Mann-Whitney U test; category-level volume comparisons were exploratory and unadjusted for multiplicity. Results. Most patients were male (59.67%) and of school age (32.90%); 65.30% of procedures were emergencies. Appendicitis and its complications were the leading indication (1,524; 44.25%), followed by abdominal wall and inguinoscrotal conditions (606; 17.60%) and soft-tissue masses (192; 5.57%). Total monthly volume was unchanged during the pandemic (48.20 versus 47.00 per month; p = 0.932), but its composition shifted: emergency procedures rose from 63.61% to 69.25% (χ²=9.90, df = 1, p = 0.002), the case-mix distribution changed (χ²=67.53, df = 16, p &lt; 0.001), and the age distribution shifted toward adolescents (χ²=60.24, df = 4, p &lt; 0.001). Of sixteen categories, three changed nominally significantly in volume: congenital and craniofacial defects (− 61.32%; p = 0.030), airway procedures (− 58.46%; p = 0.017), and appendicitis (+ 21.88%; p = 0.009). No laparoscopic inguinal hernia repair was recorded. Conclusion. Overall pediatric surgical volume was preserved, but the pandemic significantly redistributed it from elective toward emergency activity and toward older children, in a Latin American middle-income setting.</p>