儿童 COVID-19 与阑尾炎的临床结局：倾向评分匹配分析。

Clinical outcomes of children with COVID-19 and appendicitis: a propensity score matched analysis.

机构信息

Division of Pediatric Surgery, Department of Surgery, Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, 4650 Sunset Blvd, Mailstop #100, Los AngelesLos Angeles, CACA, 90027, USA.

Division of Pediatric Hospital Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.

出版信息

Pediatr Surg Int. 2024 Oct 8;40(1):266. doi: 10.1007/s00383-024-05817-7.

DOI:10.1007/s00383-024-05817-7

PMID:39377975

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11461633/

Abstract

OBJECTIVE

Early in the COVID-19 pandemic, many children with appendicitis and COVID-19 were initially treated non-operatively and later underwent interval appendectomy. Currently, children with both appendicitis and COVID-19 frequently undergo upfront appendectomy. The impact of this return to upfront surgical management on patient outcomes is unknown. This study compared outcomes of pediatric patients with and without COVID-19 infection undergoing appendectomy.

STUDY DESIGN

A retrospective cohort study of children < 21y who underwent appendectomy from 3/19/2020 to 7/31/2022 at 50 Pediatric Health Information System children's hospitals was conducted. Children with documented COVID-19 were identified. Exclusions included preoperative ventilator or supplemental oxygen dependence, and missing data. To evaluate COVID-19 positive versus COVID-19 negative patients, we used a propensity score matched on sociodemographics, comorbidities, laparoscopy, perforation, and hospital. Chi-square and Mann-Whitney U tests identified differences between groups in length of stay, postoperative drain placement, 30-day re-admission, and mechanical ventilation requirements.

RESULTS

Overall, 51,861 children of median age 11y (IQR: 8-14) underwent appendectomy, of whom 1,440 (2.3%) had COVID-19. Most were male (60.3%), White (72.1%) and non-Hispanic (61.4%). Public insurance was the most common (47.5%). We created a matched cohort of 1,360 COVID-19 positive and 1,360 COVID-19 negative children. Children with COVID-19 had shorter hospitalizations (1d, IQR: 1-4 vs. 2d, IQR: 1-5, p = 0.03), less postoperative peritoneal drain placement (2.4% vs. 4.1%, p = 0.01), and fewer 30-day readmissions (9.0% vs. 11.4%, p = 0.04). However, no difference in incidence or duration of mechanical ventilation (p > 0.05) was detected.

CONCLUSIONS

Our findings suggest that upfront appendectomy for children with appendicitis and COVID-19 has similar outcomes compared to children without COVID-19.

LEVEL OF EVIDENCE

Level III.

摘要

目的

在新冠大流行早期，许多患有阑尾炎和新冠的儿童最初接受非手术治疗，然后进行间隔性阑尾切除术。目前，患有阑尾炎和新冠的儿童经常接受直接阑尾切除术。这种回归直接手术管理对患者结局的影响尚不清楚。本研究比较了患有和不患有新冠感染的行阑尾切除术的儿科患者的结局。

研究设计

这是一项回顾性队列研究，纳入了 2020 年 3 月 19 日至 2022 年 7 月 31 日期间在 50 家儿科健康信息系统儿童医院接受阑尾切除术的 <21 岁的儿童。确定了有记录的新冠患儿。排除了术前需要呼吸机或补充氧气以及缺少数据的患儿。为了评估新冠阳性与新冠阴性患儿，我们采用了基于社会人口统计学、合并症、腹腔镜检查、穿孔和医院的倾向评分匹配。采用卡方检验和曼-惠特尼 U 检验比较两组间住院时间、术后引流管放置、30 天再入院和机械通气需求的差异。

结果

总体而言，51861 名中位年龄为 11 岁（IQR：8-14）的儿童接受了阑尾切除术，其中 1440 名（2.3%）患有新冠。大多数为男性（60.3%）、白人（72.1%）和非西班牙裔（61.4%）。最常见的保险类型是公共保险（47.5%）。我们创建了一个匹配的队列，包括 1360 名新冠阳性和 1360 名新冠阴性患儿。新冠患儿的住院时间更短（1 天，IQR：1-4 与 2 天，IQR：1-5，p=0.03），术后腹腔引流管放置更少（2.4%与 4.1%，p=0.01），30 天再入院率更低（9.0%与 11.4%，p=0.04）。然而，机械通气的发生率或持续时间无差异（p>0.05）。