Impact of the novel coronavirus on surgical practices at a tertiary pediatric hospital: A 3 year cross-sectional study

Abstract

Objective The novel coronavirus (COVID-19) forced unprecedented changes in pediatric otolaryngology workflow in the early pandemic, particularly due to the postponement of elective procedures. In turn, this has impacted timely treatment of patients and ability to train residents and fellows. The objective is to characterize how surgical practices in pediatric otolaryngology have been impacted by the pandemic through a cross sectional analysis over three years. Methods This cross-sectional study focuses on patients who underwent surgical procedures within the department of otolaryngology at a single tertiary pediatric hospital. Descriptive statistical analysis was used to compare subsets of patients from pre-pandemic in 2019, early-pandemic in 2020, and late-pandemic in 2021. Results Operative volume decreased by 87.57% in the early pandemic and 36.86% in the late pandemic. In the early pandemic, the greatest decreases were seen in airway reconstruction (100%), adenotonsillectomy (96.4%), adenoidectomy (94.7%), myringotomy with tympanostomy tube insertion (94.6%), frenulectomy (94.1%), and sinonasal procedures (93.3%), while in the late-pandemic adenotonsillectomy (42.4%) and myringotomy with tympanostomy tube insertion (70.1%) remained reduced when compared to pre-pandemic volume. Increased average case lengths in the early-pandemic (78.28 ± 51.95 min) and late-pandemic (71.91 ± 70.76 min) were observed when compared to pre-pandemic (52.26 ± 39.20 min) (p < 0.001). An increased proportion of multidisciplinary cases were completed in 2020 and 2021 (p < 0.001). In the 2020, 25% of cases were completed without trainee involvement. There was an overall decrease in case numbers for trainees and increase in cases without their involvement when compared to 2019 and 2021. Conclusion The COVID-19 pandemic resulted in a decrease in pediatric otolaryngology surgical procedures, particularly at the onset of the pandemic. While surgical trainees saw a dramatic reduction in case numbers early on, one year into the pandemic case volume is increasing and trending to pre-pandemic numbers. More complex cases, as represented by patients requiring longer operative times, inpatient status, and more frequently multidisciplinary care, were seen in the early pandemic, while drastic reductions were seen in routine outpatient procedures.

Telehealth Adoption and Perspectives Among Pediatric Otolaryngologists Following the COVID-19 Pandemic

“…Within pediatric otolaryngology, complex patients required follow-up care during this time, despite institutions reporting a reduction in clinical volume or cases. 12,13 In personal communications, colleagues have described the pandemic as a technological disruptor, forcing clinicians to embrace new software or devices to conduct patient visits from a distance. Yet, there are few studies reporting outcomes of the adoption of telehealth among otolaryngologists or describing use beyond the lockdown periods after emergence from the pandemic lifestyle.…”

“…Within pediatric otolaryngology, complex patients required follow-up care during this time, despite institutions reporting a reduction in clinical volume or cases. 12,13…”

Effects of Sociodemographic and Child Opportunity Index on Pediatric Plastic and Oral and Maxillofacial Surgical Volume Trends in the COVID-19 Pandemic

“…3,4 Several studies suggest that this downstream effect of COVID-19 may have maintained or exacerbated disparities related to equitable access and delivery of needed pediatric surgical care early in the pandemic. [5][6][7] Craniofacial/Pediatric…”