Division of Otolaryngology, George Washington University Hospital, 900 23rd Street NW, Washington, DC, 20037, USA.
Department of Otolaryngology, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA.
Int J Pediatr Otorhinolaryngol. 2021 Dec;151:110923. doi: 10.1016/j.ijporl.2021.110923. Epub 2021 Sep 13.
The novel coronavirus (COVID-19) forced unprecedented changes in pediatric otolaryngology workflow in the early pandemic, particularly due to the postponement of elective procedures. In turn, this has impacted timely treatment of patients and ability to train residents and fellows. The objective is to characterize how surgical practices in pediatric otolaryngology have been impacted by the pandemic through a cross sectional analysis over three years.
This cross-sectional study focuses on patients who underwent surgical procedures within the department of otolaryngology at a single tertiary pediatric hospital. Descriptive statistical analysis was used to compare subsets of patients from pre-pandemic in 2019, early-pandemic in 2020, and late-pandemic in 2021.
Operative volume decreased by 87.57% in the early pandemic and 36.86% in the late pandemic. In the early pandemic, the greatest decreases were seen in airway reconstruction (100%), adenotonsillectomy (96.4%), adenoidectomy (94.7%), myringotomy with tympanostomy tube insertion (94.6%), frenulectomy (94.1%), and sinonasal procedures (93.3%), while in the late-pandemic adenotonsillectomy (42.4%) and myringotomy with tympanostomy tube insertion (70.1%) remained reduced when compared to pre-pandemic volume. Increased average case lengths in the early-pandemic (78.28 ± 51.95 min) and late-pandemic (71.91 ± 70.76 min) were observed when compared to pre-pandemic (52.26 ± 39.20 min) (p < 0.001). An increased proportion of multidisciplinary cases were completed in 2020 and 2021 (p < 0.001). In the 2020, 25% of cases were completed without trainee involvement. There was an overall decrease in case numbers for trainees and increase in cases without their involvement when compared to 2019 and 2021.
The COVID-19 pandemic resulted in a decrease in pediatric otolaryngology surgical procedures, particularly at the onset of the pandemic. While surgical trainees saw a dramatic reduction in case numbers early on, one year into the pandemic case volume is increasing and trending to pre-pandemic numbers. More complex cases, as represented by patients requiring longer operative times, inpatient status, and more frequently multidisciplinary care, were seen in the early pandemic, while drastic reductions were seen in routine outpatient procedures.
新型冠状病毒（COVID-19）在大流行早期迫使儿科耳鼻喉科的工作流程发生了前所未有的变化，尤其是由于择期手术的推迟。这反过来又影响了患者的及时治疗以及培训住院医生和研究员的能力。本研究的目的是通过对三年的横断面分析，描述儿科耳鼻喉科手术实践受大流行影响的情况。
本横断面研究的重点是在一家三级儿科医院耳鼻喉科进行手术的患者。使用描述性统计分析比较了 2019 年大流行前、2020 年大流行早期和 2021 年大流行后期的患者亚组。
大流行早期手术量减少了 87.57%，大流行后期减少了 36.86%。在大流行早期，气道重建（100%）、腺样体扁桃体切除术（96.4%）、腺样体切除术（94.7%）、鼓膜切开术伴鼓膜置管术（94.6%）、系带切除术（94.1%）和鼻-鼻窦手术（93.3%）降幅最大，而在大流行后期，与大流行前相比，腺样体扁桃体切除术（42.4%）和鼓膜切开术伴鼓膜置管术（70.1%）仍有所减少。与大流行前相比（52.26±39.20 min），大流行早期（78.28±51.95 min）和大流行后期（71.91±70.76 min）的平均手术时间明显延长（p<0.001）。2020 年和 2021 年完成的多学科病例比例增加（p<0.001）。2020 年，25%的病例在没有住院医生参与的情况下完成。与 2019 年和 2021 年相比，住院医生的病例数量总体减少，而没有他们参与的病例数量增加。
COVID-19 大流行导致儿科耳鼻喉科手术数量减少，尤其是在大流行开始时。尽管外科住院医生的病例数量在早期急剧减少，但一年后，病例数量增加，且呈上升趋势，接近大流行前的水平。在大流行早期，需要更长手术时间、住院和更频繁多学科治疗的患者代表更复杂的病例，而常规门诊手术则大幅减少。
