COVID-19 大流行政策对小儿急性阑尾炎手术的意外后果。
Unanticipated consequences of COVID-19 pandemic policies on pediatric acute appendicitis surgery.
机构信息
Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada; Institute of Medial Science, University of Toronto, Toronto, ON, M5S 1A8, Canada; Department of Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada.
Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada.
出版信息
J Pediatr Surg. 2023 May;58(5):931-938. doi: 10.1016/j.jpedsurg.2023.01.021. Epub 2023 Jan 20.
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 coronavirus disease 2019 (COVID-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 COVID-19 (February 2020-June 2021) cohorts. Primary outcomes included complicated appendicitis rates (perforation/abscess/bowel obstruction), COVID-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 COVID-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 COVID-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 COVID-19. The pre-pandemic cohort had a significantly younger age distribution.
CONCLUSION
Pediatric appendicitis was significantly impacted during COVID-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.
LEVEL OF EVIDENCE
Level III for "Treatment Studies".
背景
全球大流行可能会限制获得专业护理的机会，从而延迟常见急性外科疾病的诊断和治疗。我们分析了新型冠状病毒病 2019（COVID-19）大流行对城市三级保健中心急性阑尾炎的影响。我们假设大流行与延迟就诊和更严重的临床后果有关，具体而言，儿童穿孔的发生率更高。
方法
我们回顾性评估了我院在大流行前对照组（2018 年 2 月至 2019 年 6 月）和 COVID-19 组（2020 年 2 月至 2021 年 6 月）期间因急性阑尾炎入院的患者。主要结局包括复杂阑尾炎发生率（穿孔/脓肿/肠梗阻）、COVID-19 状态、并发症和到我院的旅行距离。符合纳入标准的患者共 1107 例：对照组 491 例（44.4%），COVID-19 组 616 例（55.6%）。统计分析包括 t 检验、列联表和逻辑回归模型分析关键变量。
结果
COVID-19 组的复杂阑尾炎比例明显高于对照组（28.3%比 38.8%，p<0.001）。就诊时症状持续时间和住院时间无显著差异。COVID-19 组抗生素治疗时间、手术时间、再入院率和旅行距离明显更高。大流行前的队列年龄分布明显更年轻。
结论
COVID-19 期间，儿科阑尾炎显著受到影响，表现为复杂阑尾炎、手术时间和抗生素治疗时间增加。这可能是由于患者避免前往医疗机构治疗非大流行相关疾病或封锁政策的意外的次要后果。政府将所有省级小儿阑尾炎病例都转至儿科机构的政策增加了我们患者的旅行距离，并对三级医疗保健产生了意想不到的后果和资源需求。
证据水平
“治疗研究”三级。
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