Abstract
Background
The COVID-19 pandemic has impacted timely access to care for children, including patients with appendicitis. This study aimed to evaluate the effect of the COVID-19 pandemic on management of appendicitis and patient outcomes.
Methods
A multicenter retrospective study was performed including 19 children’s hospitals from April 2019-October 2020 of children (age
18 years) diagnosed with appendicitis. Groups were defined by each hospital’s city/state stay-at-home orders (SAHO), designating patients as Pre-COVID (Pre-SAHO) or COVID (Post-SAHO). Demographic, treatment, and outcome data were obtained, and univariate and multivariable analysis was performed.
Results
Of 6,014 patients, 2,413 (40.1%) presented during the COVID-19 pandemic. More patients were managed non-operatively during the COVID-19 pandemic compared to before the pandemic (147 (6.1%) vs 144 (4.0%), p < 0.001). Despite this change, there was no difference in the proportion of complicated appendicitis between groups (1,247 (34.6%) vs 849 (35.2%), p = 0.12). COVID era non-operative patients received fewer additional procedures, including interventional radiology (IR) drain placements, compared to pre-COVID non-operative patients (29 (19.7%) vs 69 (47.9%), p < 0.001). On adjusted analysis, factors associated with increased odds of receiving non-operative management included: increasing duration of symptoms (OR=1.01, 95% CI: 1.01–1.012), African American race (OR=2.4, 95% CI: 1.3–4.6), and testing positive for COVID-19 (OR=10.8, 95% CI: 5.4–21.6).
Conclusion
Non-operative management of appendicitis increased during the COVID-19 pandemic. Additionally, fewer COVID era cases required IR procedures. These changes in the management of pediatric appendicitis during the COVID pandemic demonstrates the potential for future utilization of non-operative management.
【저자키워드】 COVID-19, SARS-CoV-2, patient outcomes, Pediatric appendicitis, Non-operative management, Stay at home order, 【초록키워드】 Treatment, pandemic, pediatric, children, COVID-19 pandemic, hospital, outcome, COVID, outcomes, Retrospective study, management, Patient, Adjusted analysis, age, multicenter, group, demographic, Care, African American, patients, Appendicitis, Factor, no difference, multivariable analysis, positive, Result, defined, proportion, diagnosed, required, receiving, was performed, changes in, evaluate the effect, impacted, duration of symptom,