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Patient and Process Outcomes among Pediatric Patients Undergoing Appendectomy during the COVID-19 Pandemic: An
Clyde T Matava1, Nathaniel T G Tighe2, Reto Baertschiger3
1Department of Anesthesia and Pain Medicine, The Hospital for Sick Children. Toronto, Canada; Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Toronto. Toronto, Canada.
Insights
The COVID-19 pandemic did not significantly alter hospital length of stay for pediatric appendectomies. However, complicated appendicitis increased during the pandemic, and SARS-CoV-2 testing prolonged treatment times.
Area of Science:
- Pediatric Surgery
- Infectious Disease Epidemiology
- Healthcare Management
Background:
- The COVID-19 pandemic necessitated significant changes in healthcare delivery.
- Concerns arose regarding its impact on pediatric surgical care, specifically appendectomies.
Purpose of the Study:
- To evaluate the effect of the COVID-19 pandemic on timely access to care, perioperative processes, and clinical outcomes for pediatric appendectomy patients.
- To compare outcomes between a prepandemic period and early pandemic period.
Main Methods:
- A retrospective, international, multicenter study using matched cohorts from the PEdiatric Anesthesia COVID-19 Collaborative (PEACOC).
- Matched patients (under 18) based on age, ASA status, and sex.
- Primary outcome: difference in hospital length of stay; Secondary outcomes: time to appendectomy and complicated appendicitis incidence.
Main Results:
- A total of 3,351 cases were analyzed (1,684 pandemic, 1,618 prepandemic).
- Hospital length of stay showed a statistically significant but small difference (29h pandemic vs. 28h prepandemic).
- Complicated appendicitis increased during the pandemic (24.1% vs. 18.6%), and SARS-CoV-2 testing was associated with longer time to appendectomy and hospital stay.
Conclusions:
- The COVID-19 pandemic did not significantly impact hospital length of stay for pediatric appendectomies.
- Increased rates of complicated appendicitis and delays due to testing were observed during the pandemic.
Background:
COVID-19 forced healthcare systems to make unprecedented changes in clinical care processes. The authors hypothesized that the COVID-19 pandemic adversely impacted timely access to care, perioperative processes, and clinical outcomes for pediatric patients undergoing primary appendectomy.
Methods:
A retrospective, international, multicenter study was conducted using matched cohorts within participating centers of the international PEdiatric Anesthesia COVID-19 Collaborative (PEACOC). Patients younger than 18 yr old were matched using age, American Society of Anesthesiologists Physical Status, and sex. The primary outcome was the difference in hospital length of stay of patients undergoing primary appendectomy during a 2-month period early in the COVID-19 pandemic (April to May 2020) compared with prepandemic (April to May 2019). Secondary outcomes included time to appendectomy and the incidence of complicated appendicitis.
Results:
A total of 3,351 cases from 28 institutions were available with 1,684 cases in the prepandemic cohort matched to 1,618 in the pandemic cohort. Hospital length of stay was statistically significantly different between the two groups: 29 h (interquartile range: 18 to 79) in the pandemic cohort versus 28 h (interquartile range: 18 to 67) in the prepandemic cohort (adjusted coefficient, 1 [95% CI, 0.39 to 1.61]; P < 0.001), but this difference was small. Eight centers demonstrated a statistically significantly longer hospital length of stay in the pandemic period than in the prepandemic period, while 13 were shorter and 7 did not observe a statistically significant difference. During the pandemic period, there was a greater occurrence of complicated appendicitis, prepandemic 313 (18.6%) versus pandemic 389 (24.1%), an absolute difference of 5.5% (adjusted odds ratio, 1.32 [95% CI, 1.1 to 1.59]; P = 0.003). Preoperative SARS-CoV-2 testing was associated with significantly longer time-to-appendectomy, 720 min (interquartile range: 430 to 1,112) with testing versus 414 min (interquartile range: 231 to 770) without testing, adjusted coefficient, 306 min (95% CI, 241 to 371; P < 0.001), and longer hospital length of stay, 31 h (interquartile range: 20 to 83) with testing versus 24 h (interquartile range: 14 to 68) without testing, adjusted coefficient, 7.0 (95% CI, 2.7 to 11.3; P = 0.002).
Conclusions:
For children undergoing appendectomy, the COVID-19 pandemic did not significantly impact hospital length of stay.
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