University of Massachusetts Medical School, Worcester, Massachusetts.
Department of Surgery, University of Massachusetts Medical School-Baystate Medical Center, Springfield, Massachusetts.
J Surg Res. 2022 Nov;279:299-303. doi: 10.1016/j.jss.2022.06.019. Epub 2022 Jun 21.
The purpose of this study was to evaluate changes to acute pediatric surgical needs during the early phase of the SARS-Cov2 (COVID-19) pandemic.
We performed a retrospective cohort study of all in-hospital pediatric surgery consultations placed through the consult paging system at a single institution. We compared both median and absolute differences for emergency department (ED), operative, and hospital outcomes between March, April, and May of 2019 versus 2020.
There were 225 in-hospital pediatric surgery consults in 2019 and 123 in 2020. Overall, mean age was 8.4-y (standard deviation = 6.4) and 60% were male. Initial vitals were similar between years and a similar proportion of patients underwent laboratory and imaging tests. In 2020, children spent a median of 1.1-h fewer in the ED (95% confidence interval = -2.2, -0.1) and 0.9-h fewer in the ED before surgical consultation (95% confidence interval = -1.5, -0.3) compared to 2019. Patients required significantly more procedures in the ED in 2020 (n = 16, 14.3%) than 2019 (n = 13, 6.2%) (P = 0.02), most commonly laceration repairs. In 2019, 46 children (20.4% of all consults in 2019) presented with appendicitis and 27 children (22.0% of all consults in 2020) in 2020. Complicated appendicitis was more common in 2020 (n = 12, 44.4%) than 2019 (n = 9, 19.6%) (P = 0.02). Two children (7.4%) were managed nonoperatively with a drain in 2020 compared to none in 2019 (P = 0.13). Median time from surgical consultation to surgery, median operative time, and median time to discharge was similar for children with appendicitis in both years.
The early phase of the pandemic was associated with more efficient triaging in the ED, but more ED procedures and more complex surgical pathology.
本研究旨在评估 SARS-CoV2（COVID-19）大流行早期阶段急性儿科手术需求的变化。
我们对单家医院通过咨询分页系统进行的所有院内儿科手术咨询进行了回顾性队列研究。我们比较了 2019 年 3 月、4 月和 5 月与 2020 年相比，急诊科（ED）、手术和住院结局的中位数和绝对差异。
2019 年有 225 例院内儿科手术咨询，2020 年有 123 例。总体而言，平均年龄为 8.4 岁（标准差=6.4），60%为男性。患儿初诊生命体征在不同年份相似，进行实验室和影像学检查的患儿比例也相似。与 2019 年相比，2020 年患儿在急诊科的停留时间中位数减少了 1.1 小时（95%置信区间= -2.2，-0.1），在接受手术咨询前在急诊科的停留时间中位数减少了 0.9 小时（95%置信区间= -1.5，-0.3）。与 2019 年相比，2020 年在急诊科接受的手术明显增多（n=16，占 2020 年所有咨询的 14.3%），而 2019 年为 13 例（占所有咨询的 6.2%）（P=0.02），最常见的是裂伤修复术。2019 年，46 例患儿（2019 年所有咨询的 20.4%）表现为阑尾炎，2020 年有 27 例患儿（2020 年所有咨询的 22.0%）。与 2019 年相比，2020 年复杂阑尾炎更为常见（n=12，占 44.4%），而 2019 年为 9 例（占 19.6%）（P=0.02）。与 2019 年相比，2020 年有 2 例患儿（7.4%）用引流管非手术治疗，而 2019 年没有患儿（P=0.13）。在这两年中，阑尾炎患儿从手术咨询到手术、手术时间中位数和出院时间中位数相似。
大流行的早期阶段与急诊科分诊效率的提高有关，但急诊科手术增多，手术病理更为复杂。
