Clinical outcomes of children with COVID-19 and appendicitis: a propensity score matched analysis
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In brief
In brief
This multi-center retrospective study compared outcomes of upfront appendectomy in children with and without COVID-19 infection during the pandemic. Using propensity-matched cohorts, researchers found that children with COVID-19 actually had shorter hospital stays, fewer drain placements, and lower readmission rates, suggesting COVID-19 status should not delay surgical management of appendicitis.
- Children with COVID-19 and appendicitis can safely undergo upfront appendectomy with outcomes similar to COVID-negative patients.
- COVID-positive children had shorter hospital stays (1 vs 2 days) and fewer postoperative complications than matched controls.
- No difference in mechanical ventilation rates between COVID-positive and COVID-negative pediatric appendectomy patients.
- Early pandemic non-operative management is no longer necessary; upfront surgical approach is safe for COVID-positive children.
- Propensity-matched analysis of 1,360 pairs showed lower drain placement (2.4% vs 4.1%) and readmissions (9.0% vs 11.4%) in COVID group.
Written by the GCMD Library team from the article.
Abstract
Objective
Early in the COVID-19 pandemic, many children with appendicitis and COVID-19 were initially treated non-operatively and later underwent interval appendectomy. Currently, children with both appendicitis and COVID-19 frequently undergo upfront appendectomy. The impact of this return to upfront surgical management on patient outcomes is unknown. This study compared outcomes of pediatric patients with and without COVID-19 infection undergoing appendectomy.
Study design
A retrospective cohort study of children < 21y who underwent appendectomy from 3/19/2020 to 7/31/2022 at 50 Pediatric Health Information System children’s hospitals was conducted. Children with documented COVID-19 were identified. Exclusions included preoperative ventilator or supplemental oxygen dependence, and missing data. To evaluate COVID-19 positive versus COVID-19 negative patients, we used a propensity score matched on sociodemographics, comorbidities, laparoscopy, perforation, and hospital. Chi-square and Mann–Whitney U tests identified differences between groups in length of stay, postoperative drain placement, 30-day re-admission, and mechanical ventilation requirements.
Results
Overall, 51,861 children of median age 11y (IQR: 8–14) underwent appendectomy, of whom 1,440 (2.3%) had COVID-19. Most were male (60.3%), White (72.1%) and non-Hispanic (61.4%). Public insurance was the most common (47.5%). We created a matched cohort of 1,360 COVID-19 positive and 1,360 COVID-19 negative children. Children with COVID-19 had shorter hospitalizations (1d, IQR: 1–4 vs. 2d, IQR: 1–5, p = 0.03), less postoperative peritoneal drain placement (2.4% vs. 4.1%, p = 0.01), and fewer 30-day readmissions (9.0% vs. 11.4%, p = 0.04). However, no difference in incidence or duration of mechanical ventilation (p > 0.05) was detected.
Conclusions
Our findings suggest that upfront appendectomy for children with appendicitis and COVID-19 has similar outcomes compared to children without COVID-19.
Level of evidence
Level III.