The COVID‐19 pandemic first wave in Sweden: A national registry study of the effects on pediatric anesthesia and surgery

Abstract

Background The COVID‐19 pandemic is pushing healthcare systems to their limits. Dramatic reductions in the adult elective surgery are ubiquitous, but corresponding changes in pediatric services are not well described. The Swedish Perioperative Registry contains data on all anesthetic procedures in Sweden, and therefore, provides a unique opportunity to analyze the effect of the pandemic on the pediatric anesthesia capacity on a national level. We hypothesized that there would be a significant reduction in pediatric elective procedures. The aim was to determine the effects on pediatric surgical and anesthetic services during the first wave of the COVID‐19 pandemic in Sweden. Methods For this retrospective registry cohort study, we extracted all procedures performed on patients <18 years of age in 2020 and 2019. Weeks 12 to 26 of 2020 were defined as the first wave, and data were analyzed according to level of care, type of surgery, procedure code, and emergency or elective surgery. Results We found 7015 fewer procedures during the first wave epoch. Elective cases were reduced by 53.7% while emergency surgery was not significantly affected. During the peak of the first wave in April, there was a 72.8% reduction in elective cases; ENT/maxillofacial surgery showed the greatest reduction (86.7%). The surgical and anesthesia capacity recovered to near‐normal levels by the end of June 2020. Conclusion We conclude that the impact of COVID‐19 on pediatric surgical procedures in Sweden during the first wave of the pandemic was dramatic, but elective services were restored a few months after the peak.

The Swedish Perioperative Register: Description, validation of data mapping and utility

“…Thus, the reduced surgical resources were prioritized for these patients. This chosen strategy resembles the prioritization observed and reported in other studies 18–22 …”

Impact of the COVID-19 Pandemic on Emergency Care Utilization and Outcomes in Pediatric Patients with Intussusception

“…Failure to access life-saving treatments can increase the severity of the disease, causing complications and even death [ 6 ]. During the COVID-19 pandemic, changes in the diagnosis and treatment results for abdominal pain requiring surgery, such as acute appendicitis, and even changes in treatment trends, have been actively reported [ 7 , 8 , 9 , 10 , 11 , 12 ]. On the other hand, there have been few reports of intussusceptions in pediatric patients.…”

Ad-hoc preoperative management and respiratory events in pediatric anesthesia during the first COVID-19 lockdown–an observational cohort study

“…Its first wave in early 2020 caught the medical community with no pertinent guidelines or standard operation procedures on hand. Swift implementation of unprecedented management strategies was required to maintain a basic level of surgical and anesthetic care [ 3 , 4 , 21 , 22 ], and surgical procedures had to be cancelled in large numbers to keep intensive care resources in supply and protect medical staff [ 10 , 23 , 24 ]. Given the paramount role of social distancing in bringing down infection rates, the focus was on minimizing contacts between staff and patients.…”

“…Since its outbreak, many healthcare providers have been forced to modify their standard procedures to meet the special challenges arising from the crisis [2][3][4][5][6][7][8][9]. Elective surgery was postponed extensively and treatment of outpatients dramatically reduced [10,11]. The rationale of subjecting clinical routines to these modifications was to ensure 'social distancing' aimed at minimizing the risk of transmitting COVID-19 between patients and medical staff [12].…”