The safety of paediatric surgery between COVID‐19 surges: an observational study

Abstract

Summary Despite the ongoing coronavirus disease 2019 (COVID‐19) pandemic, elective paediatric surgery must continue safely through the first, second and subsequent waves of disease. This study presents outcome data from a children's hospital in north‐west England, the region with the highest prevalence of COVID‐19 in England. Children and young people undergoing elective surgery isolated within their household for 14 days, then presented for real‐time reverse transcriptase polymerase chain reaction testing for severe acute respiratory syndrome coronavirus disease‐2 (SARS‐CoV‐2) within 72 h of their procedure (or rapid testing within 24 h in high‐risk cases), and completed a screening questionnaire on admission. Planned surgery resumed on 26 May 2020; in the four subsequent weeks, there were 197 patients for emergency and 501 for elective procedures. A total of 488 out of 501 (97.4%) elective admissions proceeded, representing a 2.6% COVID‐19‐related cancellation rate. There was no difference in the incidence of SARS‐CoV‐2 among children and young people who had or had not isolated for 14 days (p > 0.99). One out of 685 (0.1%) children who had surgery re‐presented to the hospital with symptoms potentially consistent with SARS‐CoV‐2 within 14 days of surgery. Outcomes were similar to those in the same time period in 2019 for length of stay (p = 1.0); unplanned critical care admissions (p = 0.59); and 14‐day hospital re‐admission (p = 0.17). However, the current cohort were younger (p = 0.037); of increased complexity (p < 0.001) and underwent more complex surgery (p < 0.001). The combined use of household self‐isolation, testing and screening questionnaires has allowed the re‐initiation of elective paediatric surgery at high volume while maintaining pre‐COVID‐19 outcomes in children and young people undergoing surgery. This may provide a model for addressing the ongoing challenges posed by COVID‐19, as well as future pandemics.

Diagnostic tool or screening programme? Asymptomatic testing for SARS-CoV-2 needs clear goals and protocols

“…Individual organisations have used increased testing capacity to test people without symptoms with the aim of reducing transmission of SARS-CoV-2 [ 6 , 7 ]. Asymptomatic screening has been adopted in hospital settings to guide both infection control practices around those with higher risk of being infectious and timings of treatment for other conditions (such as elective surgery and cancer chemotherapy) where there may be a higher risk of adverse outcomes if infected [8] , [9] , [10] , [11] . It has been adopted in community settings to allow rapid isolation and cohorting of infectious individuals in facilities and hence to reduce morbidity and mortality from institutional outbreaks [12] , [13] , [14] .…”

The COVID‐19 pandemic first wave in Sweden: A national registry study of the effects on pediatric anesthesia and surgery

“…A possible explanation is that pediatric centers adapted rapidly to the pandemic, implementing strict algorithms for testing children scheduled for surgery, similar to other published data. [25][26][27] Furthermore, compared with adult services, it is our impression that pediatric centers may have been relatively less taxed by allocation of staff to COVID-19 wards and intensive care units. Having said this, the SPOR data indicate that the second wave of the pandemic may have started to have effects on the healthcare system as early as a few months after returning to normal in June (Figure 1).…”

A survey of the global impact of COVID‐19 on the practice of pediatric anesthesia: A study from the pediatric anesthesia COVID‐19 Collaborative Group

“…Much of the current pediatric anesthesia COVID-19 literature is focused on how to care for children in the perioperative setting, including methods for the resumption of elective outpatient surgery through preoperative testing. [8][9][10] COVID-19 directly impacted anesthesiologists because their own health is at risk when caring for infected patients. In addition, the pandemic increased emotional stress and created the possibility of adverse financial impact.…”

“…Anesthesiology, including pediatric anesthesiology, has been greatly impacted by COVID‐19, not just in the delivery of care to patients but for the individual anesthesiology providers as well. Much of the current pediatric anesthesia COVID‐19 literature is focused on how to care for children in the perioperative setting, including methods for the resumption of elective outpatient surgery through preoperative testing 8‐10 …”