The effect of Covid-19 on pediatric surgical case volume.

Abstract

Introduction The COVID-19 pandemic has had an unprecedented ef- fect on hospital systems. Policy changes lead to de- creased hospital visits as well as surgical case volume. The literature on pediatric surgical case volume during the pandemic is sparse. Throughout the country, hospitals sought various policies to preserve personal protective equipment and other hospital resources, and to minimize avoidable peri- and postoperative sequelae due to COVID-19 infection. Our hospital first placed a hold on all elective surgeries. Later, all elective cases required a preoperative negative COVID test prior to proceed- ing. We sought to review the sequelae of our hospital’s policy in response to COVID-19. We identified trends in surgical case volume and cancellations due to a positive COVID-19 test. We also reviewed postoperative out- comes of cases with a positive test. Material and Methods This study was approved by the institutional IRB. Data was retrospectively collected on all surgical cases at our children’s hospital between March 2019 and March 2021. We marked the start of the COVID-19 pandemic as March 2020, when elective cases were suspended. A required preoperative negative COVID-19 test was im- plemented in May 2020. We identified pre-operative COVID-19 test results,the posted urgency of each case and 30-day outcomes from medical records. Results From March 2019 to March 2021, we identified 25,496 completed surgeries and 3,503 cancellations. 12,024 ca- ses proceeded during the first year of the pandemic, which appeared lower, compared to pre-pandemic case numbers. Of those, 2,785 (23%) cases were considered urgent or emergent. The average number of completed monthly cases fell from a pre-pandemic number of 1,123 to a pandemic number of 925. When comparing to a pre- pandemic month, average monthly case volume declined by 19%, with the largest decline noted to be 66%. There was a monthly average of 189 total cancellations between March 2020 and March 2021. 34 (18%) of those were for a positive preoperative COVID test. A total of 139 sur- geries commenced despite concomitant COVID-19 in- fection. 25 (18 %) had identifiable respiratory symptomsdocumented preoperatively. 13 (9 %) were deemed to have a respiratory complication afterward. Of those, three patients (2%) had a prolonged, and one (1%) had an unexpected reintubation. The remaining nine (6%) pa- tients had a prolonged oxygen requirement. Conclusion The COVID pandemic left operating rooms struggling to determine how to safely provide care to patients. This study demonstrated how the policies of one hospital af- fected the operating room case volume and how conco- mitant COVID infection affected outcomes in those that proceeded with surgery.

Keywords

• covid-19
• policy
• surgical volume