Department of Paediatric Surgery, Chittagong Medical College, Chattogram, Bangladesh.
Director, Chattogram Medical College Hospital, Chattogram, Bangladesh.
BMJ Paediatr Open. 2021 Mar 31;5(1):e001066. doi: 10.1136/bmjpo-2021-001066. eCollection 2021.
The aim of this study was to quantify the changes that occurred in the surgical services of children during the COVID-19 pandemic from the perspective of a low/middle-income country.
A case-control study was conducted at a large referral centre in Bangladesh among patients aged ≤12 years. Comparisons were made between cases admitted during a period of 'April to September 2020' () and controls during a similar period in 2019 (). The number of admissions and outpatient department (OPD) attendances, age and sex distribution, diagnosis, number and types of surgeries performed (elective vs emergency), variations in treatment of acute appendicitis, types of anaesthesia and mortality were compared.
Admissions were only 41% of previous year (635 vs 1549), and OPD attendances were only 28% of previous year (603 vs 2152). Admission of children reduced by 65.8%, but neonatal admission reduced only by 7.6%. The median age of the admitted patients was significantly lower during the pandemic period (3 vs 4 years, p<0.01). Acute appendicitis (151, 9.8%) and trauma (61, 9.6%), respectively, were the the most common causes of admission during the reference and the pandemic period. Elective surgeries were only 17% and emergency surgeries were 64% of previous year (p<0.01). Appendectomy (88, 9.1%) and laparotomy (77, 17.6%), respectively, were the most common surgeries performed during the reference and the pandemic period. Conservative treatment of acute appendicitis was more during the pandemic period (47.5% vs 28.5%, p=0.01), but patients who underwent appendectomies had more complicated appendicitis (63.3% vs 42.1%, p=0.01). In all, 90.4% of surgeries were performed by resident doctors. There were no COVID-19- related deaths.
Trauma became the most common cause of admission during the pandemic, and neonatal surgical conditions remained almost unchanged with high mortality rates. Elective procedures and laparoscopy remained low and resident doctors played a major role in providing surgical services.
本研究旨在从低收入和中等收入国家的角度定量分析 COVID-19 大流行期间儿童外科服务的变化。
在孟加拉国一家大型转诊中心，对年龄≤12 岁的患者进行了病例对照研究。将 2020 年 4 月至 9 月（病例组）期间收治的患者与 2019 年同期（对照组）收治的患者进行比较。比较两组的入院人数和门诊就诊人数、年龄和性别分布、诊断、手术数量（择期手术与急诊手术）、急性阑尾炎治疗方式的变化、麻醉方式和死亡率。
入院人数仅为去年同期的 41%（635 例比 1549 例），门诊就诊人数仅为去年同期的 28%（603 例比 2152 例）。儿童入院人数减少了 65.8%，但新生儿入院人数仅减少了 7.6%。大流行期间入院患者的中位年龄明显降低（3 岁比 4 岁，p<0.01）。急性阑尾炎（151 例，9.8%）和创伤（61 例，9.6%）分别为参考期和大流行期间最常见的入院原因。择期手术仅为去年同期的 17%，急诊手术为去年同期的 64%（p<0.01）。参考期和大流行期间最常见的手术分别为阑尾切除术（88 例，9.1%）和剖腹术（77 例，17.6%）。大流行期间急性阑尾炎的保守治疗更为常见（47.5%比 28.5%，p=0.01），但接受阑尾切除术的患者阑尾炎更为复杂（63.3%比 42.1%，p=0.01）。所有手术均由住院医生完成。没有 COVID-19 相关死亡病例。
大流行期间，创伤成为最常见的入院原因，新生儿手术情况基本不变，但死亡率仍较高。择期手术和腹腔镜手术仍然较少，住院医生在提供外科服务方面发挥了重要作用。
