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Clinical outcomes of children with COVID-19 and appendicitis: a propensity score matched analysis
Marjorie N Odegard1, Olivia A Keane2, Shadassa A Ourshalimian1
1Division of Pediatric Surgery, Department of Surgery, Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, 4650 Sunset Blvd, Mailstop #100, Los AngelesLos Angeles, CACA, 90027, USA.
Insights
Pediatric appendectomy outcomes are similar for children with and without COVID-19. Upfront surgery for appendicitis in children with COVID-19 infection shows comparable results to those without the virus.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Epidemiology
Background:
- Early COVID-19 pandemic saw non-operative management for pediatric appendicitis with COVID-19, followed by interval appendectomy.
- Current practice favors upfront appendectomy for children with appendicitis and COVID-19.
- The impact of this shift on patient outcomes remains unclear.
Purpose of the Study:
- To compare surgical outcomes in pediatric patients who underwent appendectomy, stratified by COVID-19 status.
- To evaluate the safety and efficacy of upfront appendectomy in children with concurrent appendicitis and COVID-19.
Main Methods:
- Retrospective cohort study at 50 children's hospitals.
- Included children under 21 undergoing appendectomy between March 2020 and July 2022.
- Propensity score matching was used to compare COVID-19 positive and negative patients, analyzing length of stay, drain placement, readmissions, and mechanical ventilation.
Main Results:
- A matched cohort of 1,360 COVID-19 positive and 1,360 COVID-19 negative children was analyzed.
- Children with COVID-19 experienced shorter hospitalizations (1 day vs. 2 days) and less postoperative drain placement (2.4% vs. 4.1%).
- Thirty-day readmission rates were lower in the COVID-19 group (9.0% vs. 11.4%), with no significant difference in mechanical ventilation requirements.
Conclusions:
- Upfront appendectomy for pediatric appendicitis in the context of COVID-19 infection yields comparable outcomes to those without COVID-19.
- The study supports the current surgical management approach for children with appendicitis and COVID-19.
- No increased risk in ventilation needs was observed for COVID-19 positive patients undergoing appendectomy.
Objective:
Early in the COVID-19 pandemic, many children with appendicitis and COVID-19 were initially treated non-operatively and later underwent interval appendectomy. Currently, children with both appendicitis and COVID-19 frequently undergo upfront appendectomy. The impact of this return to upfront surgical management on patient outcomes is unknown. This study compared outcomes of pediatric patients with and without COVID-19 infection undergoing appendectomy.
Study Design:
A retrospective cohort study of children < 21y who underwent appendectomy from 3/19/2020 to 7/31/2022 at 50 Pediatric Health Information System children's hospitals was conducted. Children with documented COVID-19 were identified. Exclusions included preoperative ventilator or supplemental oxygen dependence, and missing data. To evaluate COVID-19 positive versus COVID-19 negative patients, we used a propensity score matched on sociodemographics, comorbidities, laparoscopy, perforation, and hospital. Chi-square and Mann-Whitney U tests identified differences between groups in length of stay, postoperative drain placement, 30-day re-admission, and mechanical ventilation requirements.
Results:
Overall, 51,861 children of median age 11y (IQR: 8-14) underwent appendectomy, of whom 1,440 (2.3%) had COVID-19. Most were male (60.3%), White (72.1%) and non-Hispanic (61.4%). Public insurance was the most common (47.5%). We created a matched cohort of 1,360 COVID-19 positive and 1,360 COVID-19 negative children. Children with COVID-19 had shorter hospitalizations (1d, IQR: 1-4 vs. 2d, IQR: 1-5, p = 0.03), less postoperative peritoneal drain placement (2.4% vs. 4.1%, p = 0.01), and fewer 30-day readmissions (9.0% vs. 11.4%, p = 0.04). However, no difference in incidence or duration of mechanical ventilation (p > 0.05) was detected.
Conclusions:
Our findings suggest that upfront appendectomy for children with appendicitis and COVID-19 has similar outcomes compared to children without COVID-19.
Level Of Evidence:
Level III.
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