TY - JOUR
T1 - Management of pediatric appendicitis during the COVID-19 pandemic
T2 - A nationwide multicenter cohort study
AU - Hegde, Brittany
AU - Garcia, Elisa
AU - Hu, Andrew
AU - Raval, Mehul
AU - Takirambudde, Sanyu
AU - Wakeman, Derek
AU - Lewit, Ruth
AU - Gosain, Ankush
AU - Parrado, Raphael H.
AU - Cina, Robert A.
AU - Stephenson, Krista
AU - Dassinger, Melvin S.
AU - Zhang, Daniel
AU - Mustafa, Moiz M.
AU - Koo, Donna
AU - Lipskar, Aaron M.
AU - Scheidler, Katherine
AU - Van Arendonk, Kyle J.
AU - Berg, Patrick
AU - Gonzalez, Raquel
AU - Scheese, Daniel
AU - Haynes, Jeffrey
AU - Mina, Alexander
AU - Zamora, Irving J.
AU - Lopez, Monica E.
AU - Mehl, Steven C.
AU - Gilliam, Elizabeth
AU - Lofberg, Katrina
AU - Spencer, Brianna
AU - Kulaylat, Afif N.
AU - Gulack, Brian C.
AU - Johnson, Matthew
AU - Laskovy, Matthew
AU - Brahmamdam, Pavan
AU - Shimomura, Aoi
AU - Blanch, Therese
AU - Tsao, Kuo Jen
AU - Slater, Bethany J.
N1 - Publisher Copyright:
© 2022
PY - 2023/7
Y1 - 2023/7
N2 - Background: The COVID-19 pandemic has impacted timely access to care for children, including patients with appendicitis. This study aimed to evaluate the effect of the COVID-19 pandemic on management of appendicitis and patient outcomes. Methods: A multicenter retrospective study was performed including 19 children's hospitals from April 2019-October 2020 of children (age≤18 years) diagnosed with appendicitis. Groups were defined by each hospital's city/state stay-at-home orders (SAHO), designating patients as Pre-COVID (Pre-SAHO) or COVID (Post-SAHO). Demographic, treatment, and outcome data were obtained, and univariate and multivariable analysis was performed. Results: Of 6,014 patients, 2,413 (40.1%) presented during the COVID-19 pandemic. More patients were managed non-operatively during the COVID-19 pandemic compared to before the pandemic (147 (6.1%) vs 144 (4.0%), p < 0.001). Despite this change, there was no difference in the proportion of complicated appendicitis between groups (1,247 (34.6%) vs 849 (35.2%), p = 0.12). COVID era non-operative patients received fewer additional procedures, including interventional radiology (IR) drain placements, compared to pre-COVID non-operative patients (29 (19.7%) vs 69 (47.9%), p < 0.001). On adjusted analysis, factors associated with increased odds of receiving non-operative management included: increasing duration of symptoms (OR=1.01, 95% CI: 1.01–1.012), African American race (OR=2.4, 95% CI: 1.3–4.6), and testing positive for COVID-19 (OR=10.8, 95% CI: 5.4–21.6). Conclusion: Non-operative management of appendicitis increased during the COVID-19 pandemic. Additionally, fewer COVID era cases required IR procedures. These changes in the management of pediatric appendicitis during the COVID pandemic demonstrates the potential for future utilization of non-operative management.
AB - Background: The COVID-19 pandemic has impacted timely access to care for children, including patients with appendicitis. This study aimed to evaluate the effect of the COVID-19 pandemic on management of appendicitis and patient outcomes. Methods: A multicenter retrospective study was performed including 19 children's hospitals from April 2019-October 2020 of children (age≤18 years) diagnosed with appendicitis. Groups were defined by each hospital's city/state stay-at-home orders (SAHO), designating patients as Pre-COVID (Pre-SAHO) or COVID (Post-SAHO). Demographic, treatment, and outcome data were obtained, and univariate and multivariable analysis was performed. Results: Of 6,014 patients, 2,413 (40.1%) presented during the COVID-19 pandemic. More patients were managed non-operatively during the COVID-19 pandemic compared to before the pandemic (147 (6.1%) vs 144 (4.0%), p < 0.001). Despite this change, there was no difference in the proportion of complicated appendicitis between groups (1,247 (34.6%) vs 849 (35.2%), p = 0.12). COVID era non-operative patients received fewer additional procedures, including interventional radiology (IR) drain placements, compared to pre-COVID non-operative patients (29 (19.7%) vs 69 (47.9%), p < 0.001). On adjusted analysis, factors associated with increased odds of receiving non-operative management included: increasing duration of symptoms (OR=1.01, 95% CI: 1.01–1.012), African American race (OR=2.4, 95% CI: 1.3–4.6), and testing positive for COVID-19 (OR=10.8, 95% CI: 5.4–21.6). Conclusion: Non-operative management of appendicitis increased during the COVID-19 pandemic. Additionally, fewer COVID era cases required IR procedures. These changes in the management of pediatric appendicitis during the COVID pandemic demonstrates the potential for future utilization of non-operative management.
KW - COVID-19
KW - Non-operative management
KW - Patient outcomes
KW - Pediatric appendicitis
KW - SARS-CoV-2
KW - Stay at home order
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U2 - 10.1016/j.jpedsurg.2022.08.005
DO - 10.1016/j.jpedsurg.2022.08.005
M3 - Article
C2 - 36075771
AN - SCOPUS:85137388462
SN - 0022-3468
VL - 58
SP - 1375
EP - 1382
JO - Journal of pediatric surgery
JF - Journal of pediatric surgery
IS - 7
ER -