BACKGROUND: Pediatric surgical care is limited in Afghanistan. Few details are known about the state of pediatric surgery in Afghanistan. We explore the impact of a newly installed pediatric operating room by a children's charity on the provision of pediatric surgery in Afghanistan. STUDY DESIGN: Following the opening in March 2023 of the new KidsOR operating room at Ataturk Hospital in Kabul, Afghanistan, perioperative clinical data was prospectively collected until December 2023. All children (age <
14 years) undergoing surgical procedures were included in a REDCap database, and descriptive analyses were performed. RESULTS: 1,014 operations were performed during the study period. The patients originated (73%) from Kabul Province
80% were male. 34% of the surgeries were emergencies. Mean age was 6.5 years old. Those who received elective surgery were on average younger (age 5.2 years) compared to those receiving emergency surgery (age 7.6 years (p<
0.0001). The most common emergent diagnoses were appendicitis (52%), intussusception (9%), genitourinary pathologies (8.7%), and neurosurgical trauma (6.1%). The most common elective cases were hernias 27%, undescended testes (18%), hypospadias/epispadias (9%), urinary tract stones (8%), hydrocele/spermatocele/varicocele (7%), gastrointestinal pathologies (7%), and neurosurgical disorders (6%). The most frequent procedures were appendectomy (18%), inguinal hernia repair (17%), and orchidopexy (13%). Mortality and infectious complication rates were both 0.3%. CONCLUSIONS: This is the largest study on the provision of pediatric surgical care in Afghanistan, demonstrating the successful implementation of infrastructure for surgical capacity in a low-resource setting with a complex political status. Future efforts to quantify the burden of untreated pediatric surgical disease in this setting should assist advocacy efforts towards resource allocation and public health initiatives. LEVEL OF EVIDENCE: Level 3 retrospective review.