Patient and Process Outcomes among Pediatric Patients Undergoing Appendectomy during the COVID-19 Pandemic: An International Retrospective Cohort Study-Reference-Cited by-同舟云学术

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

Published:2023-04-04 Issue:1 Volume:139 Page:35-48
ISSN:0003-3022
Container-title:Anesthesiology
language:en
Short-container-title:

Author:

Matava Clyde T.¹,Tighe Nathaniel T. G.²,Baertschiger Reto³,Wilder Robert T.⁴,Correll Lynnie⁵,Staffa Steven J.⁶,Zurakowski David⁷,Kato Meredith A.⁸,Meier Petra M.⁹,Raman Vidya¹⁰,Reddy Srijaya K.¹¹,Roque Remigio A.¹²,Peterson Melissa Brooks¹³,Zhong John¹⁴,Edala Thejovathi¹⁵,Greer Timothy J.¹⁶,von Ungern-Sternberg Britta S.¹⁷,Cravero Joseph¹⁸,Simpao Allan F.¹⁹,Ali Anita Akbar²⁰,Al-Rabbat Mohamad F.²¹,Brzenski Alyssa B.²²,Casey William F.²³,Chhabada Surendrasingh²⁴,Collin Michael²⁵,Dhumak Vipul J.²⁶,D’Mello Ajay²⁷,Echeverry Piedad C.²⁷,Ellison Pavithra R.²⁸,Fernandez Allison M.²⁹,Fisher Jake A.³⁰,Fuller Clinton L.³¹,Glover Chris D.³¹,Guruswamy Velu³²,Hesselink Emily B.³³,Hunyady Agnes I.³⁴,Lorinc Amanda N.³⁵,King Michael³⁶,Mihaila Lavinia³⁷,Nelson Jonathon H.³⁸,Ng Ann S.³⁹,Ramjist Joshua K.⁴⁰,Ravula Nirop R.⁴¹,Beel Elizabeth Rossmann⁴²,Rugnathx Rahil⁴³,Shaw Robert E.⁴⁴,Sheth Michelle M.⁴³,Sinha Tripiti⁴⁴,Sommerfield Aine⁴⁵,Soneru Codruta⁴⁶,Templeton Thomas W.⁴⁷,Williams R.J.⁴⁸,

Affiliation:

1. 1Department of Anesthesia and Pain Medicine, The Hospital for Sick Children. Toronto, Canada; Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Toronto. Toronto, Canada.

2. 2Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts; Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts.

3. 3Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Canada.

4. 4Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.

5. 5Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York.

6. 6Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts.

7. 7Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts; Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts.

8. 8Oregon Health & Science University, Doernbecher Children’s Hospital, Portland, Oregon.

9. 9Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts.

10. 10Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Columbus, Ohio.

11. 11Department of Anesthesiology, Division of Pediatric Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.

12. 12Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, Seattle, Washington.

13. 13Department of Anesthesiology, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.

14. 14Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Anesthesiology, Children’s Health of Dallas, Dallas, Texas.

15. 15Department of Pediatric Anesthesiology, Arkansas Children’s Hospital, Little Rock, Arkansas.

16. 16Department of Anaesthesia & Pain Management, Perth Children’s Hospital, Perth, Western Australia, Australia.

17. 17Department of Anaesthesia & Pain Management, Perth Children’s Hospital, Perth, Western Australia, Australia; Perioperative Medicine Team, Telethon Kids Institute, Perth, Western Australia, Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, The University of Western Australia, Perth, Western Australia, Australia.

18. 18Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts.

19. 19Department of Anesthesiology & Critical Care Medicine, Children’s Hospital of Philadelphia. Philadelphia, Pennsylvania; Department of Anesthesiology & Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.

20. Division of Pediatric Anesthesiology and Pain Medicine, University of Arkansas for Medical Sciences/Arkansas Children’s Hospital Served as a scientific advisor and collected data.

21. Department of Anesthesia, Sidra Medicine. Served as a scientific advisor and collected data.

22. Department of Anesthesiology, University of California - San Diego Served as a scientific advisor and collected data.

23. Department of Anesthesia, Sidra Medicine Served as a scientific advisor and collected data.

24. Department of Pediatric Anesthesiology, Cleveland Clinic Served as a scientific advisor and collected data.

25. Department of Paediatric Surgery, Perth Children’s Hospital Served as a scientific advisor and collected data.

26. Department of Anesthesiology, West Virginia University Medicine Children’s Served as a scientific advisor and collected data.

27. Department of Anesthesia and Pain Medicine, Nationwide Children’s Hospital Served as a scientific advisor and collected data.

28. Department of Anesthesiology, West Virginia University Medicine Children’s

29. Department of Anesthesia, Pain and Perioperative Medicine, Johns Hopkins All Children’s Hospital

30. Department of Anesthesiology and Pain Medicine, University of California – Davis Served as a scientific advisor and collected data.

31. Department of Anesthesiology, Perioperative and Pain Medicine, Baylor College of Medicine/Texas Children’s Hospital Served as a scientific advisor and collected data.

32. Department of Pediatric Anesthesia, Sidra Medicine Served as a scientific advisor and collected data.

33. Department of Anesthesia, University of Wisconsin-Madison Served as a scientific advisor and collected data.

34. Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital Served as a scientific advisor and collected data.

35. Department of Pediatric Anesthesiology, Lurie Children’s Hospital, Northwestern University, Feinberg School of Medicine Served as a scientific advisor and collected data

36. Department of Pediatric Anesthesiology, Lurie Children’s Hospital, Northwestern University, Feinberg School of Medicine

37. Department of Pediatric Anesthesiology, University of California – Davis Served as a scientific advisor and collected data

38. Division of Anesthesiology and Pain Medicine, Children’s National Hospital Served as a scientific advisor and collected data

39. Department of Anesthesiology, Perioperative and Pain Medicine, Baylor College of Medicine/Texas Children’s Hospital

40. Department of General Surgery, The Hospital for Sick Children Served as a scientific advisor and collected data

41. Department of Anesthesiology and Pain Medicine, University of California – Davis Served as a scientific advisor and collected data

42. Department of Anesthesiology, Perioperative and Pain Medicine, Baylor College of Medicine/Texas Children’s Hospital Served as a scientific advisor and collected data

43. Department of Anesthesiology, University of Mississippi Medical Center Served as a scientific advisor and collected data

44. Department of Anesthesia, University of Wisconsin-Madison Served as a scientific advisor and collected data

45. Department of Anaesthesia & Pain Management, Perth Children’s Hospital Served as a scientific advisor and collected data

46. Department of Anesthesiology & Critical Care Medicine, University of New Mexico Served as a scientific advisor and collected data

47. Department of Anesthesiology, Wake Forest University School of Medicine Served as a scientific advisor and collected data

48. Department of Anesthesia and Pain Medicine, Hospital for Sick Children Served as a scientific advisor and collected data

Abstract

Background COVID-19 forced healthcare systems to make unprecedented changes in clinical care processes. The authors hypothesized that the COVID-19 pandemic adversely impacted timely access to care, perioperative processes, and clinical outcomes for pediatric patients undergoing primary appendectomy. Methods A retrospective, international, multicenter study was conducted using matched cohorts within participating centers of the international PEdiatric Anesthesia COVID-19 Collaborative (PEACOC). Patients younger than 18 yr old were matched using age, American Society of Anesthesiologists Physical 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 to May 2020) compared with prepandemic (April to May 2019). Secondary outcomes included time to appendectomy and the incidence of complicated appendicitis. Results A total of 3,351 cases from 28 institutions were available with 1,684 cases in the prepandemic cohort matched to 1,618 in the pandemic cohort. Hospital length of stay was statistically significantly different between the two groups: 29 h (interquartile range: 18 to 79) in the pandemic cohort versus 28 h (interquartile range: 18 to 67) in the prepandemic 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 than in the prepandemic 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, prepandemic 313 (18.6%) versus pandemic 389 (24.1%), an absolute difference of 5.5% (adjusted odds ratio, 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 min (interquartile range: 430 to 1,112) with testing versus 414 min (interquartile range: 231 to 770) without testing, adjusted coefficient, 306 min (95% CI, 241 to 371; P < 0.001), and longer hospital length of stay, 31 h (interquartile range: 20 to 83) with testing versus 24 h (interquartile range: 14 to 68) without testing, adjusted coefficient, 7.0 (95% CI, 2.7 to 11.3; P = 0.002). Conclusions For children undergoing appendectomy, the COVID-19 pandemic did not significantly impact hospital length of stay. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Anesthesiology and Pain Medicine

Link

https://pubs.asahq.org/anesthesiology/article-pdf/139/1/35/688163/20230700.0-00012.pdf

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