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



Okonkwo, INC, Howie, A, Parry, C ORCID: 0000-0001-7563-7282, Shelton, CL, Cobley, S, Craig, R, Permall, N, El-Sheikha, SH, Herbert, N and Arnold, P
(2020) The safety of paediatric surgery between COVID-19 surges: an observational study. ANAESTHESIA, 75 (12). pp. 1605-1613.

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Abstract

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.

Item Type: Article
Uncontrolled Keywords: COVID-19, elective surgery, paediatrics, testing
Depositing User: Symplectic Admin
Date Deposited: 23 Nov 2020 14:56
Last Modified: 18 Jan 2023 23:21
DOI: 10.1111/anae.15264
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3107255