Unanticipated consequences of COVID-19 pandemic policies on pediatric acute appendicitis surgery

Paula R Quaglietta; Joshua K Ramjist; Jeffrey Antwi; Ashby Kissoondoyal; Eveline Lapidus-Krol; Reto M Baertschiger

doi:10.1016/j.jpedsurg.2023.01.021

Unanticipated consequences of COVID-19 pandemic policies on pediatric acute appendicitis surgery

J Pediatr Surg. 2023 May;58(5):931-938. doi: 10.1016/j.jpedsurg.2023.01.021. Epub 2023 Jan 20.

Authors

Paula R Quaglietta¹, Joshua K Ramjist², Jeffrey Antwi², Ashby Kissoondoyal³, Eveline Lapidus-Krol², Reto M Baertschiger⁴

Affiliations

¹ Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada; Institute of Medial Science, University of Toronto, Toronto, ON, M5S 1A8, Canada; Department of Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada.
² Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada.
³ Department of Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada.
⁴ Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada; Institute of Medial Science, University of Toronto, Toronto, ON, M5S 1A8, Canada; Department of Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada. Electronic address: Reto.Baertschiger@sickkids.ca.

Abstract

Background: Global pandemics may limit access to specialized care, delaying diagnosis and treatment of common acute surgical diseases. We analyzed the impact of the novel coronavirus disease 2019 (COVID-19) pandemic on acute appendicitis at an urban tertiary care center. We hypothesize that pandemics are associated with delayed presentation and worsened clinical sequelae, specifically, higher incidences of perforation in children.

Methods: We retrospectively assessed patients admitted to our institution with acute appendicitis in pre-pandemic control (February 2018-June 2019) and COVID-19 (February 2020-June 2021) cohorts. Primary outcomes included complicated appendicitis rates (perforation/abscess/bowel obstruction), COVID-19 status, complications and travel distance to our institution. 1107 patients met inclusion criteria: 491 (44.4%) during the control period and 616 (55.6%) in the COVID-19 cohort. Statistical analysis involved t-tests, contingency tables and logistic regression modelling for key variables.

Results: A larger proportion of complicated appendicitis occurred during COVID-19 compared to controls (28.3% vs 38.8%, p < 0.001). Symptom duration at presentation and length of stay were not significantly different. Duration of antibiotic treatment, surgery length, readmission rate and travel distances were significantly higher during COVID-19. The pre-pandemic cohort had a significantly younger age distribution.

Conclusion: Pediatric appendicitis was significantly impacted during COVID-19, demonstrated by increased rates of complicated appendicitis, surgery duration and antibiotic duration. This may be an unintended secondary consequence of patients avoiding healthcare facilities for non-pandemic related illnesses or lockdown policies. Government policies directing all provincial pediatric appendicitis cases to pediatric institutions increased travel distances for our patients and had unanticipated consequences and resource requirements on tertiary healthcare.

Level of evidence: Level III for "Treatment Studies".

Keywords: Acute appendicitis; COVID-19; General surgery; Travel to tertiary care.

MeSH terms

Acute Disease
Anti-Bacterial Agents
Appendectomy
Appendicitis* / epidemiology
Appendicitis* / surgery
COVID-19* / epidemiology
Child
Communicable Disease Control
Humans
Pandemics
Policy
Retrospective Studies

Substances

Anti-Bacterial Agents