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The safety of paediatric surgery between COVID-19 surges: an observational study
I N C Okonkwo1, A Howie1, C Parry2,3
1Jackson Rees Department of Anaesthesia, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
Insights
Elective paediatric surgery can resume safely during the COVID-19 pandemic using household isolation and SARS-CoV-2 testing. This approach maintained pre-pandemic surgical outcomes for children and young people.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Public Health
Background:
- The COVID-19 pandemic necessitated adaptations in healthcare delivery, including paediatric surgery.
- Maintaining essential surgical services while mitigating infection risk is crucial.
Purpose of the Study:
- To evaluate the safety and outcomes of re-initiating elective paediatric surgery during the COVID-19 pandemic.
- To assess the effectiveness of pre-operative isolation and testing protocols.
Main Methods:
- Implementation of 14-day household self-isolation for patients prior to surgery.
- Real-time reverse transcriptase polymerase chain reaction (RT-PCR) testing for severe acute respiratory syndrome coronavirus disease-2 (SARS-CoV-2) within 72 hours of procedure.
- Use of screening questionnaires on admission and monitoring for post-operative SARS-CoV-2 symptoms.
Main Results:
- A low COVID-19-related cancellation rate of 2.6% was observed.
- No significant difference in SARS-CoV-2 incidence was found between isolated and non-isolated groups.
- Post-operative outcomes, including length of stay and re-admission rates, were comparable to pre-pandemic levels.
Conclusions:
- Combined household isolation, testing, and screening effectively enabled high-volume elective paediatric surgery during the pandemic.
- The established protocols allowed for the safe resumption of paediatric surgical services without compromising patient outcomes.
- This model offers a potential framework for managing surgical services during current and future pandemics.
Abstract:
Despite the ongoing coronavirus disease 2019 (COVID-19) pandemic, elective paediatric surgery must continue safely through the first, second and subsequent waves of disease. This study presents outcome data from a children's hospital in north-west England, the region with the highest prevalence of COVID-19 in England. Children and young people undergoing elective surgery isolated within their household for 14 days, then presented for real-time reverse transcriptase polymerase chain reaction testing for severe acute respiratory syndrome coronavirus disease-2 (SARS-CoV-2) within 72 h of their procedure (or rapid testing within 24 h in high-risk cases), and completed a screening questionnaire on admission. Planned surgery resumed on 26 May 2020; in the four subsequent weeks, there were 197 patients for emergency and 501 for elective procedures. A total of 488 out of 501 (97.4%) elective admissions proceeded, representing a 2.6% COVID-19-related cancellation rate. There was no difference in the incidence of SARS-CoV-2 among children and young people who had or had not isolated for 14 days (p > 0.99). One out of 685 (0.1%) children who had surgery re-presented to the hospital with symptoms potentially consistent with SARS-CoV-2 within 14 days of surgery. Outcomes were similar to those in the same time period in 2019 for length of stay (p = 1.0); unplanned critical care admissions (p = 0.59); and 14-day hospital re-admission (p = 0.17). However, the current cohort were younger (p = 0.037); of increased complexity (p < 0.001) and underwent more complex surgery (p < 0.001). The combined use of household self-isolation, testing and screening questionnaires has allowed the re-initiation of elective paediatric surgery at high volume while maintaining pre-COVID-19 outcomes in children and young people undergoing surgery. This may provide a model for addressing the ongoing challenges posed by COVID-19, as well as future pandemics.
