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Management of pediatric appendicitis during the COVID-19 pandemic: A nationwide multicenter cohort study
Brittany Hegde1, Elisa Garcia2, Andrew Hu3
1Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States of America; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States of America; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, United States of America.
Insights
The COVID-19 pandemic saw an increase in non-operative management for pediatric appendicitis. Fewer interventional radiology procedures were needed during this period, suggesting potential for future use of non-operative approaches.
Area of Science:
- Pediatric Surgery
- Infectious Disease Epidemiology
- Healthcare Management
Background:
- The COVID-19 pandemic significantly disrupted healthcare access for pediatric patients, including those with appendicitis.
- Timely diagnosis and treatment of appendicitis in children may have been affected by pandemic-related challenges.
Purpose of the Study:
- To evaluate the impact of the COVID-19 pandemic on the management strategies and patient outcomes for pediatric appendicitis.
- To compare appendicitis treatment and outcomes before and during the COVID-19 pandemic.
Main Methods:
- A multicenter retrospective study analyzed data from 19 children's hospitals between April 2019 and October 2020.
- Patients were categorized into Pre-COVID (Pre-Stay-at-Home Order) and COVID (Post-Stay-at-Home Order) groups.
- Demographic, treatment, and outcome data were collected and analyzed using univariate and multivariable methods.
Main Results:
- During the COVID-19 pandemic, non-operative management of appendicitis increased significantly (6.1% vs 4.0%).
- There was no significant difference in complicated appendicitis rates between the two periods (34.6% vs 35.2%).
- Non-operative cases during the COVID era required fewer interventional radiology procedures (19.7% vs 47.9%).
Conclusions:
- Non-operative management for pediatric appendicitis became more prevalent during the COVID-19 pandemic.
- A reduction in interventional radiology procedures was observed for appendicitis cases managed non-operatively during the pandemic.
- These findings highlight the potential for increased adoption of non-operative management strategies in pediatric appendicitis in the future.
Background:
The COVID-19 pandemic has impacted timely access to care for children, including patients with appendicitis. This study aimed to evaluate the effect of the COVID-19 pandemic on management of appendicitis and patient outcomes.
Methods:
A multicenter retrospective study was performed including 19 children's hospitals from April 2019-October 2020 of children (age≤18 years) diagnosed with appendicitis. Groups were defined by each hospital's city/state stay-at-home orders (SAHO), designating patients as Pre-COVID (Pre-SAHO) or COVID (Post-SAHO). Demographic, treatment, and outcome data were obtained, and univariate and multivariable analysis was performed.
Results:
Of 6,014 patients, 2,413 (40.1%) presented during the COVID-19 pandemic. More patients were managed non-operatively during the COVID-19 pandemic compared to before the pandemic (147 (6.1%) vs 144 (4.0%), p < 0.001). Despite this change, there was no difference in the proportion of complicated appendicitis between groups (1,247 (34.6%) vs 849 (35.2%), p = 0.12). COVID era non-operative patients received fewer additional procedures, including interventional radiology (IR) drain placements, compared to pre-COVID non-operative patients (29 (19.7%) vs 69 (47.9%), p < 0.001). On adjusted analysis, factors associated with increased odds of receiving non-operative management included: increasing duration of symptoms (OR=1.01, 95% CI: 1.01-1.012), African American race (OR=2.4, 95% CI: 1.3-4.6), and testing positive for COVID-19 (OR=10.8, 95% CI: 5.4-21.6).
Conclusion:
Non-operative management of appendicitis increased during the COVID-19 pandemic. Additionally, fewer COVID era cases required IR procedures. These changes in the management of pediatric appendicitis during the COVID pandemic demonstrates the potential for future utilization of non-operative management.
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