Cargando…

Unanticipated consequences of COVID-19 pandemic policies on pediatric acute appendicitis surgery

BACKGROUND: Global pandemics may limit access to specialized care, delaying diagnosis and treatment of common acute surgical diseases. We analyzed the impact of the novel coronavirus disease 2019 (COVID-19) pandemic on acute appendicitis at an urban tertiary care center. We hypothesize that pandemic...

Descripción completa

Detalles Bibliográficos
Autores principales: Quaglietta, Paula R., Ramjist, Joshua K., Antwi, Jeffrey, Kissoondoyal, Ashby, Lapidus-Krol, Eveline, Baertschiger, Reto M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9851992/
https://www.ncbi.nlm.nih.gov/pubmed/36775681
http://dx.doi.org/10.1016/j.jpedsurg.2023.01.021
_version_ 1784872524577767424
author Quaglietta, Paula R.
Ramjist, Joshua K.
Antwi, Jeffrey
Kissoondoyal, Ashby
Lapidus-Krol, Eveline
Baertschiger, Reto M.
author_facet Quaglietta, Paula R.
Ramjist, Joshua K.
Antwi, Jeffrey
Kissoondoyal, Ashby
Lapidus-Krol, Eveline
Baertschiger, Reto M.
author_sort Quaglietta, Paula R.
collection PubMed
description BACKGROUND: Global pandemics may limit access to specialized care, delaying diagnosis and treatment of common acute surgical diseases. We analyzed the impact of the novel coronavirus disease 2019 (COVID-19) pandemic on acute appendicitis at an urban tertiary care center. We hypothesize that pandemics are associated with delayed presentation and worsened clinical sequelae, specifically, higher incidences of perforation in children. METHODS: We retrospectively assessed patients admitted to our institution with acute appendicitis in pre-pandemic control (February 2018–June 2019) and COVID-19 (February 2020–June 2021) cohorts. Primary outcomes included complicated appendicitis rates (perforation/abscess/bowel obstruction), COVID-19 status, complications and travel distance to our institution. 1107 patients met inclusion criteria: 491 (44.4%) during the control period and 616 (55.6%) in the COVID-19 cohort. Statistical analysis involved t-tests, contingency tables and logistic regression modelling for key variables. RESULTS: A larger proportion of complicated appendicitis occurred during COVID-19 compared to controls (28.3% vs 38.8%, p < 0.001). Symptom duration at presentation and length of stay were not significantly different. Duration of antibiotic treatment, surgery length, readmission rate and travel distances were significantly higher during COVID-19. The pre-pandemic cohort had a significantly younger age distribution. CONCLUSION: Pediatric appendicitis was significantly impacted during COVID-19, demonstrated by increased rates of complicated appendicitis, surgery duration and antibiotic duration. This may be an unintended secondary consequence of patients avoiding healthcare facilities for non-pandemic related illnesses or lockdown policies. Government policies directing all provincial pediatric appendicitis cases to pediatric institutions increased travel distances for our patients and had unanticipated consequences and resource requirements on tertiary healthcare. LEVEL OF EVIDENCE: Level III for “Treatment Studies”.
format Online
Article
Text
id pubmed-9851992
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Elsevier Inc.
record_format MEDLINE/PubMed
spelling pubmed-98519922023-01-20 Unanticipated consequences of COVID-19 pandemic policies on pediatric acute appendicitis surgery Quaglietta, Paula R. Ramjist, Joshua K. Antwi, Jeffrey Kissoondoyal, Ashby Lapidus-Krol, Eveline Baertschiger, Reto M. J Pediatr Surg Article BACKGROUND: Global pandemics may limit access to specialized care, delaying diagnosis and treatment of common acute surgical diseases. We analyzed the impact of the novel coronavirus disease 2019 (COVID-19) pandemic on acute appendicitis at an urban tertiary care center. We hypothesize that pandemics are associated with delayed presentation and worsened clinical sequelae, specifically, higher incidences of perforation in children. METHODS: We retrospectively assessed patients admitted to our institution with acute appendicitis in pre-pandemic control (February 2018–June 2019) and COVID-19 (February 2020–June 2021) cohorts. Primary outcomes included complicated appendicitis rates (perforation/abscess/bowel obstruction), COVID-19 status, complications and travel distance to our institution. 1107 patients met inclusion criteria: 491 (44.4%) during the control period and 616 (55.6%) in the COVID-19 cohort. Statistical analysis involved t-tests, contingency tables and logistic regression modelling for key variables. RESULTS: A larger proportion of complicated appendicitis occurred during COVID-19 compared to controls (28.3% vs 38.8%, p < 0.001). Symptom duration at presentation and length of stay were not significantly different. Duration of antibiotic treatment, surgery length, readmission rate and travel distances were significantly higher during COVID-19. The pre-pandemic cohort had a significantly younger age distribution. CONCLUSION: Pediatric appendicitis was significantly impacted during COVID-19, demonstrated by increased rates of complicated appendicitis, surgery duration and antibiotic duration. This may be an unintended secondary consequence of patients avoiding healthcare facilities for non-pandemic related illnesses or lockdown policies. Government policies directing all provincial pediatric appendicitis cases to pediatric institutions increased travel distances for our patients and had unanticipated consequences and resource requirements on tertiary healthcare. LEVEL OF EVIDENCE: Level III for “Treatment Studies”. Elsevier Inc. 2023-05 2023-01-20 /pmc/articles/PMC9851992/ /pubmed/36775681 http://dx.doi.org/10.1016/j.jpedsurg.2023.01.021 Text en © 2023 Elsevier Inc. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Article
Quaglietta, Paula R.
Ramjist, Joshua K.
Antwi, Jeffrey
Kissoondoyal, Ashby
Lapidus-Krol, Eveline
Baertschiger, Reto M.
Unanticipated consequences of COVID-19 pandemic policies on pediatric acute appendicitis surgery
title Unanticipated consequences of COVID-19 pandemic policies on pediatric acute appendicitis surgery
title_full Unanticipated consequences of COVID-19 pandemic policies on pediatric acute appendicitis surgery
title_fullStr Unanticipated consequences of COVID-19 pandemic policies on pediatric acute appendicitis surgery
title_full_unstemmed Unanticipated consequences of COVID-19 pandemic policies on pediatric acute appendicitis surgery
title_short Unanticipated consequences of COVID-19 pandemic policies on pediatric acute appendicitis surgery
title_sort unanticipated consequences of covid-19 pandemic policies on pediatric acute appendicitis surgery
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9851992/
https://www.ncbi.nlm.nih.gov/pubmed/36775681
http://dx.doi.org/10.1016/j.jpedsurg.2023.01.021
work_keys_str_mv AT quagliettapaular unanticipatedconsequencesofcovid19pandemicpoliciesonpediatricacuteappendicitissurgery
AT ramjistjoshuak unanticipatedconsequencesofcovid19pandemicpoliciesonpediatricacuteappendicitissurgery
AT antwijeffrey unanticipatedconsequencesofcovid19pandemicpoliciesonpediatricacuteappendicitissurgery
AT kissoondoyalashby unanticipatedconsequencesofcovid19pandemicpoliciesonpediatricacuteappendicitissurgery
AT lapiduskroleveline unanticipatedconsequencesofcovid19pandemicpoliciesonpediatricacuteappendicitissurgery
AT baertschigerretom unanticipatedconsequencesofcovid19pandemicpoliciesonpediatricacuteappendicitissurgery