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 - Funding Information:
We would like to acknowledge all additional research personnel that assisted with data collection and data entry at all included centers and their contributions to this manuscript. Thomas F. Hamner, BSA, Daniel J. Kim, BS, Claire E. Wilkin, BS. Financial Support Statement: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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.
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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 -