Unanticipated consequences of COVID-19 pandemic policies on pediatric acute appendicitis surgery | Pre-pandemic (Feb 2018-June 2019) | COVID-19 (Feb 2020-June 2021) | Retrospective study of patients admitted to a single institution with acute appendicitis | 1107 patients | 44.4% pre-pandemic cohort (n=491) | 55.6% COVID-19 cohort (n=616) | Complicated appendicitis (perforation/abscess/bowel obstruction) rates: 28.3% vs. 38.8% (p < 0.001) (higher in COVID-19 cohort) | Duration of antibiotic treatment | Surgery length | were significantly higher in COVID-19 cohort | Readmission rates | Travel distances | Symptom duration at presentation and length of stay at hospital were not significantly different | The pre-pandemic cohort had a significantly younger age distribution | Conclusion: During COVID-19, pediatric appendicitis cases had increased rates of complicated appendicitis, surgery duration & antibiotic duration. Also government policies increased travel distances for patients and had unanticipated consequences and resource requirements. | https://doi.org/10.1016/j.jpedsurg.2023.01.021 | Source: Quaglietta PR et al. | The Hospital for Sick Children & University of Toronto, Toronto, ON, Canada | @EmTombash | @StayCurrentMD | Cincinnati Children's | Journal of Pediatric Surgery
Unanticipated consequences of C0VID-19 pandemic policies on pediatric acute appendicitis surgery
Infographic · Jul 2023 · 1 min read
In brief
In brief
Retrospective study of 1,107 pediatric appendicitis cases found significantly higher rates of complicated appendicitis (38.8% vs 28.3%) during COVID-19 compared to pre-pandemic controls. Pandemic policies centralizing care increased travel distances and resource burden while patients delayed seeking care for non-COVID conditions.
- Complicated appendicitis rates increased 37% during COVID-19 (38.8% vs 28.3%), likely due to delayed care-seeking behavior.
- Centralization policies routing all pediatric appendicitis to tertiary centers increased travel distances and resource strain.
- Surgery duration, antibiotic duration, and readmission rates were significantly higher during the pandemic period.
- Pandemic avoidance of healthcare facilities for non-COVID illnesses led to worse surgical outcomes in children.
- Public health policies during pandemics can have unintended consequences on acute surgical disease management.
Written by the GCMD Library team from the infographic.
The infographic uses a teal and coral color scheme with illustrated medical professionals at the bottom. Key statistics are displayed in large colored text boxes, with a calendar icon and appendix illustration as visual anchors. Bullet points organize findings in the middle section, and a yellow conclusion banner spans the bottom.
Paula R. Quaglietta, Joshua K. Ramjist, Jeffrey Antwi, Ashby Kissoondoyal, Eveline Lapidus-Krol, Reto M. Baertschiger
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 c*r*navirus disease 2019 (C0VID-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 C0VID-19 (February 2020–June 2021) cohorts. Primary outcomes included complicated appendicitis rates (perforation/abscess/bowel obstruction), C0VID-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 C0VID-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 C0VID-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 C0VID-19. The pre-pandemic cohort had a significantly younger age distribution.
Conclusion: Pediatric appendicitis was significantly impacted during C0VID-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.