Perioperative Management for Emergency Surgery in Pediatric Patients with COVID-19: Retrospective Observational Study

Abstract

Gezy Giwangkancana,1 Ezra Oktaliansah,1 Andi Ade W Ramlan,2 Arie Utariani,3 Putu Kurniyanta,4 Hasanul Arifin,5 Yunita Widyastuti,6 Astrid Pratiwi,7 Rusmin Syukur8 1Department of Anesthesia and Intensive Care, Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin National Referral and Teaching Hospital, Bandung, Indonesia; 2Department of Anesthesia and Intensive Care, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo National Referral and Teaching Hospital, Jakarta, Indonesia; 3Department of Anesthesia and Intensive Care, Faculty of Medicine Universitas Airlangga/Dr. Soetomo Provincial Referral and Teaching Hospital, Surabaya, Indonesia; 4Department of Anesthesia and Intensive Care, Faculty of Medicine Universitas Udayana/ Prof Dr. I.G.N.G Ngoerah National Referral and Teaching Hospital, Bali, Indonesia; 5Department of Anesthesia and Intensive Care, Faculty of Medicine Universitas Sumatera Utara/Dr. Adam Malik National Referral and Teaching Hospital, Medan, Indonesia; 6Department of Anesthesia and Intensive Therapy, Faculty of Medicine, Public Health and Nursing Universitas Gajah Mada/Dr. Sardjito National Referral and Teaching Hospital, Yogyakarta, Indonesia; 7Department of Anesthesia and Intensive Care, Harapan Kita Mother and Child Hospital, Jakarta, Indonesia; 8Department of Anesthesia and Intensive Care Faculty of Medicine Universitas Hassanudin/ Dr. Wahidin Sudirohusodo National Referal and Teaching Hospital, Makassar, IndonesiaCorrespondence: Gezy Giwangkancana, Department of Anesthesia and Intensive Care, Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin National Referral and Teaching Hospital, RSUP Dr Hasan Sadikin, Bandung, Pasteur Street No. 38, Bandung, 40161, Indonesia, Tel [phone], Email [email protected]: The first wave of COVID-19 in 2020 created massive challenges in providing safe surgery for pediatric patients with COVID-19. Inevitably, emergency surgery and the unknown nature of the disease place a burden on the heavily challenged surgical services for pediatrics in a developing country. Lessons from the pandemic are important for future disaster planning.Aim: To describe the characteristics of pediatric surgical patients with COVID-19 undergoing emergency surgery during the first wave and its perioperative narrative in a developing country.Methods: The study was a multicenter retrospective descriptive study in eight Indonesian government-owned referral and teaching hospitals. The authors reviewed confirmed COVID-19 pediatric patients (≤ 18 years old) who underwent surgery. Institutional review board clearances were acquired, and data were evaluated in proportion and percentages. The writing of this paper follows the STROBE guidelines.Results: About 7791 pediatric surgical cases were collected, 73 matched the study criteria and 24 confirmed cases were found. Cases were more common in females (58.3%), who were above 12 years old (37.5%) and who were asymptomatic (62.5%). Laparotomy (33.3%), general anesthesia (90.4%) and intubation (80.8%) were common, while use of video laryngoscopy (40%) and rapid sequence intubation (28.8%) were rare. The mean length of stay was 12 ± 13.3 days, and in-hospital mortality was 8.3%.Discussions: Lockdown and school closure were successful in protecting children, hence the low incidence of pediatric surgical cases with COVID-19 during the first wave. Many hospitals were unprepared to perform surgery for a droplet or airborne infectious disease, and COVID-19 testing was not available nationally in the early pandemic, hence the use of protective protection equipment during these early pandemic times are often not efficient.Conclusion: The incidence of COVID-19 in pediatric surgical patients is low. The rapidity and availability of preoperative testing for a new emerging disease are essential in a pandemic.Keywords: COVID-19, emergency surgery, operating room, pandemic, pediatric anesthesia, pediatric surgery, perioperative

Keywords

• covid-19
• emergency surgery
• operating room
• pandemic
• pediatric anesthesia
• pediatric surgery
• perioperative.