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The Disproportionate Increase in Pediatric Laparoscopic Cholecystectomies During the COVID-19 Pandemic
Philip M Lee1, Cameron Harvey2, Eli Snyder1
1University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii.
Insights
The COVID-19 pandemic saw a rise in pediatric laparoscopic cholecystectomies, with higher average weight and BMI in patients. Procedures during this period were more urgent and had increased complications.
Area of Science:
- Pediatric Surgery
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic led to lifestyle changes, including increased sedentary behavior and obesity in children.
- Literature indicates a growing trend of obesity among pediatric patients during the pandemic.
Purpose of the Study:
- To evaluate the relationship between the COVID-19 pandemic and the number of pediatric laparoscopic cholecystectomies performed.
- To compare cholecystectomy rates and patient characteristics pre-pandemic versus during the pandemic.
Main Methods:
- Utilized National Surgical Quality Improvement Program data from 2017-2021 for patients 18 years or younger.
- Categorized surgeries into pre-COVID (2017-2018) and during COVID (2020-2021) periods.
- Analyzed case acuity, wound classification, race, weight, BMI, and complication rates.
Main Results:
- A total of 13,579 pediatric laparoscopic cholecystectomies were performed; 56.0% occurred during the COVID-19 period.
- Patients during COVID-19 had significantly higher average weight and BMI (P < 0.001), associated with increased case acuity and complications.
- Urgent/emergent cases increased significantly (P < 0.0001) during COVID-19, with a higher proportion of unfavorable wound classifications (Class III/IV).
Conclusions:
- The COVID-19 pandemic was associated with an increase in pediatric laparoscopic cholecystectomies, higher patient weight/BMI, and greater case severity.
- The rise in average weight and BMI suggests a potential link between pandemic-related isolation and cholecystectomy rates.
- Further research is needed to identify specific factors contributing to these observed trends in pediatric surgical procedures.
Introduction:
The COVID-19 pandemic limited many patients to an unhealthy, sedentary lifestyle, with literature specifically demonstrating an increasing trend of obesity in pediatric patients. The goal of this study is to assess the relationship between the COVID-19 pandemic and total number of laparoscopic cholecystectomies performed pre-COVID compared to during COVID.
Methods:
Data between 2017 and 2021 were collected from the National Surgical Quality Improvement Program on patients ≤18 ys who underwent elective or urgent cholecystectomies. Data was categorized as pre-COVID (2017-2018) or during COVID (2020-2021). Analysis subcategories included case acuity (elective versus urgent versus emergent), wound classification, race, weight, and complications.
Results:
There were 13,579 pediatric laparoscopic cholecystectomies from 2017 to 2021. The COVID group had 7605 (56.0%) cases, and pre-COVID group 5974 (44.0%). The COVID group had significantly greater average weight and body mass index (BMI) than pre-COVID group (P < 0.001). Increased BMI was associated with increased case acuity and complication rates. Minorities including African Americans and Native American/Pacific Islanders had an increase in number of cholecystectomies performed during COVID. Undergoing a cholecystectomy during COVID was more likely to be classified as urgent or emergent than pre-COVID (P < 0.0001). The COVID group overall had less favorable surgical wound classification as more were classified as class III or class IV cases.
Conclusions:
There were increases in weight/BMI, case severity, and total laparoscopic cholecystectomies performed during COVID-19. A statistically significant difference in average weight may suggest a relationship between isolation during the COVID-19 pandemic and rates of cholecystectomy. Future research is encouraged to identify contributing factors in these trends.
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