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Increases in pediatric cholecystectomy during the COVID-19 pandemic: An interrupted time series analysis
Olivia A Keane1, Shadassa Ourshalimian1, MaKayla O'Guinn1
1Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA.
Insights
Pediatric cholecystectomy increased during the COVID-19 pandemic, linked to rising childhood obesity. This study highlights a significant shift in pediatric gallbladder disease and surgical needs during this period.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Public Health
Background:
- Cholecystectomy in children is historically uncommon.
- The COVID-19 pandemic brought lifestyle changes, healthcare access delays, and increased childhood obesity.
- The pandemic's impact on pediatric gallbladder disease and cholecystectomy rates was previously unclear.
Purpose of the Study:
- To investigate the trends in pediatric cholecystectomy rates before and during the COVID-19 pandemic.
- To analyze changes in pediatric gallbladder disease and patient demographics during the pandemic.
- To assess the correlation between pandemic-related factors and the need for cholecystectomy in children.
Main Methods:
- Retrospective study of children (≤18 years) undergoing cholecystectomy between January 2016 and July 2022.
- Comparison of pediatric cholecystectomy cases before and during the COVID-19 pandemic (post-March 19, 2020).
- Bivariate comparisons and interrupted time series analysis to identify trends in case volume and disease characteristics.
Main Results:
- A total of 633 pediatric cholecystectomies were analyzed (340 during the pandemic).
- Children undergoing surgery during the pandemic had higher BMIs and obesity rates.
- Pandemic cases showed decreased symptomatic cholelithiasis but increased choledocholithiasis, gallstone pancreatitis, and chronic cholecystitis; monthly case volume significantly increased.
Conclusions:
- Pediatric cholecystectomy rates significantly increased during the COVID-19 pandemic, potentially due to rising childhood obesity.
- The study suggests a notable shift in pediatric surgical needs for gallbladder disease.
- Further research is required to understand the long-term implications for pediatric health and healthcare utilization post-pandemic.
Background:
Historically, cholecystectomy is infrequently performed in children. Lifestyle changes, delays in healthcare access, and increases in childhood obesity occurred during the COVID-2019 pandemic. It is unclear whether these changes impacted pediatric gallbladder disease and the need for cholecystectomy.
Methods:
A retrospective study of children ≤18 years old undergoing cholecystectomy from January 1, 2016, to July 31, 2022, at a tertiary children's hospital was conducted. On March 19, 2020, a statewide mandatory coronavirus disease 2019 stay-at-home policy began. Differences in children undergoing cholecystectomy before and during the pandemic were identified using bivariate comparisons. An interrupted time series analysis identified differences in case volume trends.
Results:
Overall, 633 children were identified-293 pre-pandemic and 340 pandemic. A majority were female sex (76.3%) and Hispanic (67.5%), with a median age of 15 years (interquartile range: 13.0-16.0). Children who underwent cholecystectomy during the pandemic had significantly higher body mass index (28.4 versus 25.8, P = .002), and obesity (body mass index >30) was more common (45.3% versus 31.7%, P = .001). During the pandemic, significant increases in complicated biliary disease occurred-symptomatic cholelithiasis decreased (41.5% versus 61.8%, P < .001) and choledocholithiasis (17.9% versus 11.6%, P = .026), gallstone pancreatitis (17.4% versus 10.6%, P = .015), and chronic cholecystitis (4.7% versus 1.0%, P = .007) increased. The number of cholecystectomies performed per month increased during the pandemic, and on interrupted time series analysis, there was a significant increase in month-to-month case count during the pandemic (P = .003).
Conclusion:
Cholecystectomy case volume significantly increased during the coronavirus disease 2019 pandemic, possibly secondary to increases in childhood obesity. Future studies are needed to determine whether this increased frequency of pediatric cholecystectomy is representative of broader shifts in pediatric health and healthcare use after coronavirus disease 2019.
