Trends in Paediatric surgerical volume and associated mortality in England: a nationwide study over an eight year...

Reports on delays to National Health Service (NHS) surgical care have been widespread during and after the pandemic, however the impact on paediatric surgery is poorly described.

This retrospective observational cohort study used NHS hospital data in England for children aged <18 yr undergoing surgery over an 8-yr period from 1 April 2015 to 31 December 2020, with supplementary data until March 2023. The primary outcome was in-hospital mortality within 90 days after surgery. The secondary outcome was hospital stay. We report trends in annual surgical procedure volume and mortality. Frequencies presented as n (%).

We identified 36 605 870 surgical procedures, between 1 April 2015 and 31 December 2020, of which 1 846 965 (5.0%) were for children. A total of 759 083/1 846 965 (41.1%) patients were female and 313 981 (17.0%) were from minority ethnic groups. There were 41 018/1 846 965 (2.2%) procedures among neonates, 93 872 (5.1%) for children aged 28 days to 1 yr, 532 828 (28.8%) for years 1-5, 502 971 (27.2%) for years 5-12, 361 176 (19.6%) for years 12-15, and 315 100 (17.1%) for years 15-17. Median hospital stay was 1 (0-1) day. There were 6 573/1 846 965 (0.36%) in-hospital deaths within 90 days after surgery, and a trend for increasing mortality risk between 2015 and 2020 (P<0.05). The average annual number of procedures before the pandemic (2015-19) was 340 596, decreasing to 266 049 in 2023 (22% reduction in volume).

We report the trends in paediatric surgical volume and assocaited mortality for an entire healthcare system over eight years inlcuding during the COVID-19 pandemic. One in 14 surgical procedures were performed on children, with substantially lower mortality risk than adults.