Schäfer Frank-Mattias, Meyer Johannes, Kellnar Stephan, Warmbrunn Jakob, Schuster Tobias, Simon Stefanie, Meyer Thomas, Platzer Julia, Hubertus Jochen, Seitz Sigurd T, Knorr Christian, Stehr Maximilian
Department of Pediatric Surgery and Pediatric Urology, Cnopfsche Kinderklinik, Nuremberg, Germany.
Department of Pediatric Surgery, Klinikum Dritter Orden, Munich, Germany.
Front Pediatr. 2021 May 7;9:683607. doi: 10.3389/fped.2021.683607. eCollection 2021.
Since early 2020 the COVID-19 pandemic and statutory preventive reorganization of treatment capacities with cancellation of elective surgery as well as curfew regulations led to vastly decreased utilization of primary health care. To assess whether there are negative effects on pediatric acute care in Bavaria during the spring 2020 lockdown a state-wide retrospective multi-center study was performed to analyze the rate of perforated appendicitis during lockdown. Children who have been operated on during the corresponding period in 2018/19 served as control group. Overall, 514 patients (292 boys, 222 girls) were included (2020: 176 patients; 2019: 181 patients; 2018: 157 patients). Median age was 11.2 years. Four hundred thirty-nine patients (85.4%) underwent laparoscopic surgery, 69 (13.4%) open surgery and 1.2% underwent conversion from laparoscopic to open surgery. In 2020 a perforation rate of 27.8% (49/176 patients) was found, in 2018-2019 perforation rate was 20.7% (70/338 patients, = 0.0359, Cochran-Mantel-Haenszel-Test). Subgroup analysis showed that in younger patients (≤ 11.2 years), in 2020 perforation rate was significantly higher with 37.6% (32/85 patients), while 22.2% (39/176) in 2018/2019 ( = 0.014, Fisher's exact test).In boys perforation rate was significantly higher in 2020 with 35.0% (35/100 patients) compared to 21.4% in 2018-2019 ( = 0.0165, Fisher's exact test). During the period of curfew regulations in Bavaria the rate of perforated appendicitis in childhood increased significantly, especially in younger children and boys. Potentially this has to be attributed to delayed presentation to pediatric surgery care. Because of potential long-term sequelae of perforated appendicitis these adverse effects during curfew have to be taken into account for future political decision making to ensure reasonable patient care and avoid collateral damage in near-future or on-going pandemic situations.
自2020年初以来，新冠疫情以及治疗能力的法定预防性重组（取消择期手术）和宵禁规定导致初级卫生保健的利用率大幅下降。为评估2020年春季巴伐利亚州实施封锁期间对儿科急症护理是否有负面影响，开展了一项全州范围的回顾性多中心研究，以分析封锁期间阑尾炎穿孔的发生率。将2018/19年同期接受手术的儿童作为对照组。总体而言，共纳入514例患者（292例男孩，222例女孩）（2020年：176例患者；2019年：181例患者；2018年：157例患者）。中位年龄为11.2岁。439例患者（85.4%）接受了腹腔镜手术，69例（13.4%）接受了开放手术，1.2%的患者由腹腔镜手术转为开放手术。2020年发现穿孔率为27.8%（49/176例患者），2018 - 2019年穿孔率为20.7%（70/338例患者， Cochr an - Mantel - Haenszel检验，P = 0.0359）。亚组分析显示，在年龄较小的患者（≤11.2岁）中，2020年穿孔率显著更高，为37.6%（32/85例患者），而2018/2019年为22.2%（39/176例患者）（Fisher精确检验，P = 0.014）。在男孩中，2020年穿孔率显著高于2018 - 2019年，分别为35.0%（35/100例患者）和21.4%（Fisher精确检验，P = 0.0165）。在巴伐利亚州实施宵禁规定期间，儿童阑尾炎穿孔率显著上升，尤其是年龄较小的儿童和男孩。这可能归因于小儿外科护理就诊延迟。鉴于阑尾炎穿孔可能产生长期后遗症，在未来的政策决策中必须考虑宵禁期间的这些不利影响，以确保合理的患者护理，并避免在近期或正在发生的疫情情况下造成附带损害。
