{
  "abstract": "Introduction\n\nAround 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 are lacking in many low- and middle-income countries on how these measures impact healthcare utilisation and outcomes. This study aims to determine the impact of COVID-19 restrictions on volumes of the three emergency bellwether procedures in South and Southeast Asia.Methods\n\nThis was an interrupted time series study of patients who underwent any of the three emergency bellwether procedures (caesarean section, laparotomy and open fracture fixation) from 1 January 2018 to 31 December 2021 at one of eight 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 levels of COVID-19 restrictions using selected indicators from a city-level and hospital-level response index.Results\n\nWeekly volumes of emergency caesarean section decreased significantly in Guwahati Neurological Research Centre (GNRC) (p=1.62×10⁻⁵) and Ulin General Hospital (UGH) (p<2.2×10⁻¹⁶) but increased in Adam Malik Hospital (AMH) (p=1.45×10⁻⁵). For laparotomies, volume increased in Singapore General Hospital (p=2.38×10⁻⁵) but decreased in Military Hospital 175 (p=6.30×10⁻⁷). The volume of open fracture fixations decreased in GNRC (p=3.08×10⁻⁸), AMH (p=1.68×10⁻⁶) and UGH (p=8.15×10⁻⁶).Conclusions\n\nCOVID-19 restrictions on the city and hospital level were associated with a decrease in surgical volumes of the three bellwether procedures in some of the institutions. There was some suggestion of surgical capacity limitations in UGH and Military Hospital 175 during periods of more stringent COVID-19 restrictions.",
  "abstract_shown": true,
  "affiliations": [
    "Health Services Research Centre, SingHealth Group, Singapore.",
    "Health Services Research & Population Health, Duke-NUS Medical School, Singapore.",
    "School of Biological Sciences, Nanyang Technological University, Singapore.",
    "Department of Neurology, GNRC Hospitals Ltd, Guwahati, Assam, India.",
    "Department of General Surgery, GNRC Hospitals Ltd, Guwahati, Assam, India.",
    "Department of Research and Analytics, GNRC Hospitals Ltd, Guwahati, Assam, India.",
    "Ulin General Hospital Research Centre, Universitas Lambung Mangkurat, Banjarmasin, Indonesia.",
    "Department of Plastic Surgery, Regional Institute of Medical Sciences, Imphal, India.",
    "Department of Surgery, Adam Malik Hospital, Medan, Indonesia.",
    "Department of Obstetrics & Gynecology, Adam Malik Hospital, Medan, Indonesia.",
    "Department of Pharmacology and Therapeutics, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia.",
    "Department of Pediatrics, Faculty of Medicine, Universitas Sumatera Utara, Medan, Sumatera Utara, Indonesia.",
    "Department of Nutrition, Faculty of Medicine, Universitas Sumatera Utara, Medan, Sumatera Utara, Indonesia.",
    "Department of Surgery, Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.",
    "Department of Orthopaedic and Traumatology, Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.",
    "Department of Obstetrics and Gynaecology, Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.",
    "General Surgery Division, Department of Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia.",
    "University Malaya Medical Center, Kuala Lumpur, Malaysia.",
    "Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.",
    "Department of Information Technology, Military Hospital 175, Ho Chi Minh City, Vietnam.",
    "Department of General Planning, Military Hospital 175, Ho Chi Minh City, Vietnam.",
    "Department of Military Science, Military Hospital 175, Ho Chi Minh City, Vietnam.",
    "Emergency Department, Military Hospital 175, Ho Chi Minh City, Vietnam.",
    "Ho Chi Minh City University of Industry, Ho Chi Minh City, Vietnam.",
    "Intensive Care Department, Military Hospital 175, Ho Chi Minh City, Vietnam.",
    "Division of Surgery & Surgical Oncology, National Cancer Centre Singapore and Singapore General Hospital, Singapore.",
    "SingHealth Duke-NUS Global Health Institute, Singapore.",
    "Duke Global Health Insitute, Durham, North Carolina, USA.",
    "Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore.",
    "Department of General Surgery, Singapore General Hospital, Singapore."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 38,
  "authors": [
    {
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        0,
        1
      ],
      "name": "Sze Ling Chan",
      "orcid": "0000-0003-4272-4595"
    },
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        2
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      "name": "Jia Sheng Guan"
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        0,
        1
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      "name": "Sean Shao Wei Lam",
      "orcid": "0000-0002-0898-5858"
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        3
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      "name": "Nomal Chandra Borah",
      "orcid": "0000-0002-3526-4271"
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        4
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      "name": "Nipanka Goswami"
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        5
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      "name": "Dipika Dey",
      "orcid": "0009-0005-4901-749X"
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      "name": "Purabi Sarkar",
      "orcid": "0000-0002-3772-4008"
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        6
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      "name": "Zairin Noor"
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      "name": "Pandji Winata Nurikhwan",
      "orcid": "0000-0003-1921-3172"
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        6
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      "name": "Hariadi Yuseran"
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    {
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        6
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      "name": "Tjahyo Kelono Utomo"
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    {
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        7
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      "name": "Sanjib Singh Nepram"
    },
    {
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        7
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      "name": "Nehar Sinam"
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    {
      "affs": [
        8
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      "name": "Budi Irwan"
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    {
      "affs": [
        9
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      "name": "Muhammad Fahdy"
    },
    {
      "affs": [
        10
      ],
      "name": "Muhammad Ichwan"
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    {
      "affs": [
        11
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      "name": "Inke Nadia Diniyanti Lubis"
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    {
      "affs": [
        12
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      "name": "Dina Kumala Sari"
    },
    {
      "affs": [
        13
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      "name": "Ian Chik"
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    {
      "affs": [
        14
      ],
      "name": "Levin Kesu Belani"
    },
    {
      "affs": [
        15
      ],
      "name": "Nur Azurah Abdul Ghani"
    },
    {
      "affs": [
        13
      ],
      "name": "Razman Jarmin"
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    {
      "affs": [
        16
      ],
      "name": "April Camilla Roslani"
    },
    {
      "affs": [
        16,
        17
      ],
      "name": "Mee Hoong See",
      "orcid": "0000-0002-3966-3368"
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    {
      "affs": [
        18
      ],
      "name": "Mukhri Hamdan"
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    {
      "affs": [
        18
      ],
      "name": "Ainee Sarah Ahmad"
    },
    {
      "affs": [
        19
      ],
      "name": "Hoang Le",
      "orcid": "0009-0002-3165-3111"
    },
    {
      "affs": [
        20
      ],
      "name": "Van Thanh Nguyen"
    },
    {
      "affs": [
        21
      ],
      "name": "Tan Duy Dao",
      "orcid": "0009-0000-7055-1156"
    },
    {
      "affs": [
        22
      ],
      "name": "Thanh Tung Ton"
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    {
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        19,
        23
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      "name": "Vu Minh Duy Nguyen",
      "orcid": "0009-0005-5958-3233"
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    {
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        21
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      "name": "Thi-Ngoc Dung Nguyen",
      "orcid": "0000-0001-8122-1515"
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    {
      "affs": [
        21
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      "name": "Pham Nguyet Thanh Do",
      "orcid": "0009-0000-5931-0079"
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    {
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        24
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      "name": "Duc Thanh Bui"
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    {
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        24
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      "name": "Quoc Viet Tran"
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        25,
        26,
        27
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      "name": "Hiang Khoon Tan",
      "orcid": "0000-0002-8565-2926"
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        25,
        28
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      "name": "Pierce Kah Hoe Chow"
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    {
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        25,
        29
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      "name": "Sachin Mathur"
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  "bibtex": "https://research.draconitic.com/paper/9ek8b8d0xaq0n.bib",
  "cited_by": 0,
  "doi": "10.1136/bmjph-2024-002547",
  "fulltext_url": "https://europepmc.org/articles/PMC13691855",
  "id": "9ek8b8d0xaq0n",
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  "language": "eng",
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
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  "pdf_url": "https://europepmc.org/articles/PMC13691855?pdf=render",
  "pmcid": "PMC13691855",
  "pmid": "42920988",
  "published": "2026-10-22",
  "publisher": "BMJ Publishing Group",
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      "subfield": "oncology"
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  "title": "Impact of COVID-19 restrictions on emergency bellwether procedures in South and Southeast Asia.",
  "title_text": "Impact of COVID-19 restrictions on emergency bellwether procedures in South and Southeast Asia.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:43:08Z",
  "url": "https://research.draconitic.com/paper/9ek8b8d0xaq0n",
  "venue": "BMJ public health",
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