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Emergency Abdominal Surgery in Children With COVID-19: A National Surgical Quality Improvement Program-Pediatric
Marjorie Odegard1, Olivia A Keane1, Shadassa A Ourshalimian1
1Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California.
Insights
Coronavirus disease 2019 (COVID-19) in children undergoing emergency abdominal surgery did not lead to worse outcomes. This study found no increased risk of morbidity or mortality in pediatric patients with COVID-19.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Critical Care Medicine
Background:
- Emerging evidence links coronavirus disease 2019 (COVID-19) to increased perioperative mortality in adults.
- The impact of COVID-19 on pediatric surgical outcomes remains less understood.
- This study investigated the association between COVID-19 and outcomes in children undergoing emergency abdominal surgery.
Purpose of the Study:
- To determine if children with COVID-19 experience worse outcomes after emergency abdominal surgery compared to their non-infected peers.
- To assess the association between preoperative COVID-19 diagnosis and postoperative morbidity and mortality in pediatric surgical patients.
Main Methods:
- Analysis of the 2021 National Surgical Quality Improvement Program-Pediatric database.
- Inclusion of children under 18 who underwent emergency abdominal surgery.
- Propensity score-matched analysis comparing children with and without preoperative COVID-19 diagnosis.
- Assessment of postoperative morbidity and mortality, including a composite outcome for morbidity.
Main Results:
- Out of 13,619 children, 224 (1.6%) had COVID-19. Unadjusted analysis showed differences in wound classification and cardiac arrest rates.
- Propensity score matching created comparable groups of 224 COVID-19-positive and 224 COVID-19-negative children.
- No significant differences in postoperative morbidity or mortality were found between the matched groups.
- Logistic regression indicated no increased odds of morbidity as a composite outcome (OR: 0.65, 95% CI: 0.29-1.48).
Conclusions:
- Contrary to findings in adults, COVID-19 was not associated with worse clinical outcomes in children undergoing emergency abdominal surgery.
- Pediatric patients with COVID-19 did not experience increased postoperative morbidity or mortality after emergency abdominal surgery.
Introduction:
Evidence suggests that coronavirus disease of 2019 (COVID-19) infection is associated with increased perioperative mortality in adults. We hypothesized that children with COVID-19 had worse outcomes after emergency surgery compared to children without COVID-19.
Methods:
Children <18 y who underwent emergency abdominal surgery were included in the 2021 National Surgical Quality Improvement Program-Pediatric database. Children with COVID-19 diagnosed preoperatively were identified. A propensity score-matched analysis was performed, matching demographic and clinical factors. Postoperative morbidity and mortality were assessed. Due to event rarity, a composite outcome for postoperative morbidity was also assessed. Chi-square and Mann-Whitney U tests identified differences between groups. Logistic regression identified the odds of the composite morbidity outcome.
Results:
Overall, 13,619 children (median age 10.8 y, interquartile range: 6.4-14.2) underwent emergency abdominal surgery, of whom 224 (1.6%) had COVID-19. The majority were female (58.2%), White (61.3%), and non-Hispanic (53.4%). On unadjusted analysis, there was an association between COVID-19 status and American Society of Anesthesiologists classification (P < 0.01). A greater proportion of COVID-19-positive children had dirty/infected wounds (30.4% versus 22.2%, P < 0.01). Also, a greater proportion of COVID-19-positive children suffered cardiac arrest requiring cardiopulmonary resuscitation (1.3% versus 0.2%, P < 0.01). Matched cohorts of 224 COVID-19-positive and 224 COVID-19-negative children did not differ by demographic or clinical factors (P > 0.05). Propensity score matching did not reveal significant differences in postoperative morbidity or mortality. Children with COVID-19 did not demonstrate increased odds of morbidity analyzed as a composite outcome (odds ratio: 0.65, 95% confidence interval: 0.29-1.48, P = 0.31).
Conclusions:
Contrary to findings in adults, COVID-19 was not associated with worse clinical outcomes in children undergoing emergency abdominal surgery.
