Patient and Process Outcomes among Pediatric Patients Undergoing Appendectomy during the COVID-19 Pandemic: An International Retrospective Cohort Study

Abstract

Background COVID-19 forced healthcare systems to make unprecedented changes in clinical care processes. We hypothesized that the COVID-19 pandemic adversely impacted timely access to care, perioperative processes, and clinical outcomes for pediatric patients undergoing primary appendectomy. Methods We conducted a retrospective, international, multicenter study using matched cohorts within participating centers of the international PEdiatric Anesthesia COVID-19 Collaborative (PEACOC). Patients < 18 years old were matched using age, ASA-PS status, and sex. The primary outcome was the difference in hospital length of stay of patients undergoing primary appendectomy during a 2-month period early in the COVID-19 pandemic (April-May 2020) compared to pre-pandemic (April-May 2019). Secondary outcomes included time to appendectomy and the incidence of complicated appendicitis. Results 3351 cases from 28 institutions were available with 1684 cases in the pre-pandemic cohort matched to 1618 in the pandemic cohort. Hospital length of stay was statistically significantly different between the two groups: 29 hours (IQR: 18, 67) in the pandemic cohort versus 28 hours (IQR: 18, 79) in the pre-pandemic cohort (adjusted coefficient, 1; 95% CI 0.39 to 1.61, P<0.001), but this difference was small. Eight centers demonstrated a statistically significantly longer hospital length of stay in the pandemic period compared to the pre-pandemic period, while 13 were shorter and 7 did not observe a statistically significant difference. During the pandemic period, there was a greater occurrence of complicated appendicitis, pre-pandemic 313 (18.6%) versus pandemic 389 (24.1%), absolute difference of 5.5% (adjusted OR, 1.32; [95% CI 1.1 to 1.59]; P=0.003). Preoperative SARS CoV-2 testing was associated with significantly longer time-to-appendectomy, 720 minutes (IQR: 430, 1112) with testing versus 414 minutes (IQR: 231, 770) without testing, adjusted coefficient, 306 minutes, (95% CI 241 to 371, P <0.001), and longer hospital length of stay, 31 hours (IQR: 20, 83) with testing versus 24 hours (IQR: 14, 68) without testing, adjusted coefficient, 7.0, (95% CI 2.7 to 11.3, P=0.002). Discussion For children undergoing appendectomy, the COVID-19 pandemic did not significantly impact hospital length of stay.

Management and outcomes of acute appendicitis in children during the COVID-19 pandemic: a systematic review and meta-analysis

“…Of 528 title/abstract screened, 129 full-text articles were analyzed, 43 studies entered the qualitative analysis [ 1 – 11 , 13 , 14 , 22 – 51 ], and 36 papers were included in the meta-analysis [ 1 – 8 , 11 , 13 , 22 , 23 , 25 – 28 , 30 – 44 , 46 – 50 ] (32,704 pts, Fig. 2 ).…”

“…All the 36 studies included in the meta-analysis were retrospective observational studies [ 1 – 8 , 11 , 13 , 22 , 23 , 25 – 28 , 30 – 44 , 46 – 50 ]. None of the papers provided sample size calculations.…”