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Pediatric Cholecystectomy Case Volume and Complexity Following the COVID-19 Pandemic
Olivia A Keane1, Shadassa Ourshalimian1, Romeo Ignacio2
1Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California.
Insights
Pediatric cholecystectomy cases significantly increased during the COVID-19 pandemic, with higher complexity and patient obesity. This highlights a growing healthcare burden on children's hospitals.
Area of Science:
- Pediatric surgery
- Public health
- Epidemiology
Background:
- Cholecystectomy was historically infrequent in children.
- The COVID-19 pandemic brought lifestyle changes, healthcare access delays, and increased childhood obesity.
- The pandemic's impact on the need for pediatric cholecystectomy is not well understood.
Purpose of the Study:
- To evaluate trends in cholecystectomy case volume among children during the COVID-19 pandemic.
- To assess changes in case mix and patient demographics before and during the pandemic.
- To understand the implications for children's hospitals.
Main Methods:
- A multi-institutional retrospective cohort study of children (≤18 years) undergoing cholecystectomy.
- Data collected from January 2016 to July 2022 across 10 children's hospitals.
- Bivariate comparisons and interrupted time series analysis used to compare pre-pandemic and pandemic periods.
Main Results:
- Overall cholecystectomy volume increased during the pandemic.
- A higher proportion of Hispanic patients, increased body mass index (BMI), and obesity were observed.
- Significant increases in acute cholecystitis, choledocholithiasis, and chronic cholecystitis occurred.
- Transfers from outside hospitals and monthly case counts significantly increased.
Conclusions:
- Pediatric cholecystectomy volume and complexity rose during the COVID-19 pandemic.
- These trends may be linked to shifts in childhood health, patient transfers, and healthcare access.
- Findings indicate an increased healthcare burden on children's hospitals.
Background And Objectives:
Historically, cholecystectomy was infrequently performed in children. Lifestyle changes, delays in health care access, and increases in childhood obesity occurred during the COVID-19 pandemic. The impact of these shifts on need for cholecystectomy are poorly understood. We evaluate trends in cholecystectomy case volume among children during the COVID-19 pandemic.
Methods:
A multi-institutional retrospective cohort study was conducted for children ages 18 years and younger who underwent cholecystectomy from January 1, 2016, to July 31, 2022, at 10 children's hospitals. Differences in cholecystectomy case mix and volume before and during the pandemic were identified using bivariate comparisons and interrupted time series analysis.
Results:
Overall, 4282 children were identified: 2122 before the pandemic and 2160 during the pandemic. Most were female (74.2%) with a median age of 15 years (IQR, 13.0-16.0 years). The proportion of Hispanic (55.0% vs 60.1%; P = .01) patients, body mass index (BMI) (26.0 vs 27.1; P < .001), and obesity (BMI > 30) (30.8% vs 37.4%; P < .001) increased during the pandemic. Predicted monthly case volume increased from 40 to 100 during the pandemic. Patients transferred from an outside hospital increased (21.3% vs 28.5%; P < .001). Significant increases in acute cholecystitis (12.2% vs 17.3%; P < .001), choledocholithiasis (12.8% vs 16.5%; P = .001), gallstone pancreatitis (10.6% vs 12.4%; P = .064), and chronic cholecystitis (1.4% vs 3.2%; P < .001) also occurred. On interrupted time series analysis, change in month-to-month case count significantly increased during the pandemic (Figure 1; P < .001), which persisted after exclusion of transferred patients.
Conclusions:
Pediatric cholecystectomy case volume and complexity increased during the COVID-19 pandemic. These findings may be secondary to changes in childhood health, transfer patterns, and shifts in access, highlighting an increased health care burden on children's hospitals.
