Modeling the Trajectory of Surgical Volume Data Disrupted by COVID-19 and War Using Segmented Regression with Spline Effects: with Lens of the Tigray War

The "Saving Lives Through Safe Surgery" (SaLTS) initiative of Ethiopia was a strategic response to the recommendations of the Lancet Commission and marked as an important step in scaling up surgical care. The objectives of this study are twofold: (i) to understand how war and COVID-19 events affected surgical volume and backlog over time, (ii) to demonstrate the use of cubic spline model to fit the trajectory of surgical volume data disrupted by care disruptors such as COVID-19 and war. Spline modeling proved to be a valuable approach for analyzing disruptions in surgical care over time. The analysis revealed a clear shift in trends, with surgical volumes initially rising before being significantly affected by the onset of the COVID-19 pandemic and further impacted by the war.