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Postoperative Respiratory Complications in SARS-CoV-2 Positive Pediatric Patients Across 20 United States Hospitals:
Audra J Reiter1, Martha-Conley E Ingram1, Mehul V Raval1
1Division of Pediatric Surgery, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Surgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of Medicine, 633N. St. Clair St., 20th floor, Chicago, IL 60611, United States.
Insights
Children with asymptomatic SARS-CoV-2 infection had fewer postoperative respiratory complications than symptomatic children. This suggests careful consideration for non-urgent procedures in asymptomatic pediatric patients.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Anesthesiology
Background:
- Limited data exists on postoperative complications in pediatric patients with SARS-CoV-2.
- Evaluating the impact of symptomatic versus asymptomatic SARS-CoV-2 infection on pediatric surgical outcomes is crucial.
Purpose of the Study:
- To assess the impact of symptomatic and asymptomatic SARS-CoV-2 positivity on postoperative respiratory outcomes in children.
- To inform clinical decisions regarding surgical procedures in pediatric patients during the COVID-19 pandemic.
Main Methods:
- Retrospective cohort study of 266 pediatric patients undergoing general anesthesia across 20 hospitals.
- Primary outcome: frequency of postoperative respiratory complications (e.g., need for ventilation, pneumonia, readmissions).
- Stratified analysis by SARS-CoV-2 symptom status (preoperative cough or dyspnea).
Main Results:
- Postoperative respiratory complications occurred in 9.8% of patients, more frequently in symptomatic (30.8%) versus asymptomatic (8.7%) children (p=0.01).
- Higher ASA class and comorbidities were associated with increased risk of complications.
- Common procedures included appendectomies and fracture repairs; most surgeries were emergent/urgent.
Conclusions:
- Asymptomatic SARS-CoV-2 positive children experience significantly fewer postoperative respiratory complications.
- Consideration for relaxing restrictions on time-sensitive, non-urgent procedures in selected asymptomatic pediatric patients.
- Further research is warranted on the cost-effectiveness of routine SARS-CoV-2 testing in asymptomatic pediatric surgical patients.
Introduction:
Data examining rates of postoperative complications among SARS-CoV-2 positive children are limited. The purpose of this study was to evaluate the impact of symptomatic and asymptomatic SARS-CoV-2 positive status on postoperative respiratory outcomes for children.
Methods:
This retrospective cohort study included SARS-CoV-2 positive pediatric patients across 20 hospitals who underwent general anesthesia from March to October 2020. The primary outcome was frequency of postoperative respiratory complications, including: high-flow nasal cannula/non invasive ventilation, reintubation, pneumonia, Extracorporeal Membrane Oxygenation (ECMO), and 30-day respiratory-related readmissions or emergency department (ED) visits. Univariate analyses were used to evaluate associations between patient and procedure characteristics and stratified analyses by symptoms were performed examining incidence of complications.
Results:
Of 266 SARS-CoV-2 positive patients, 163 (61.7%) were male, and the median age was 10 years (interquartile range 4-14). The majority of procedures were emergent or urgent (n = 214, 80.5%). The most common procedures were appendectomies (n = 78, 29.3%) and fracture repairs (n = 40,15.0%). 13 patients (4.9%) had preoperative symptoms including cough or dyspnea. 26 patients (9.8%) had postoperative respiratory complications, including 15 requiring high-flow oxygen, 8 with pneumonia, 4 requiring non invasive ventilation, 3 respiratory ED visits, and 2 respiratory readmissions. Respiratory complications were more common among symptomatic patients than asymptomatic patients (30.8% vs. 8.7%, p = 0.01). Higher ASA class and comorbidities were also associated with postoperative respiratory complications.
Conclusions:
Postoperative respiratory complications are less common in asymptomatic versus symptomatic SARS-COV-2 positive children. Relaxation of COVID-19-related restrictions for time-sensitive, non urgent procedures in selected asymptomatic patients may be reasonably considered. Additionally, further research is needed to evaluate the costs and benefits of routine testing for asymptomatic patients.
Level Of Evidence:
Iii, Respiratory complications.
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