The Impact of COVID-19 on Acute Surgeries in England Among the Under-25s: A Retrospective Study of 61,360 Appendicitis and 15,850 Testicular Torsion Admissions.

Autor: Faitna P; School of Public Health, Imperial College London, London, UK. Electronic address: p.faitna@imperial.ac.uk., Harwood R; Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK., Kenny SE; Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK; NHS England and NHS Improvement, London, UK; Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK., Viner RM; Population, Policy and Practice Research Programme, UCL Institute Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK., Aylin PP; School of Public Health, Imperial College London, London, UK., Hargreaves DS; School of Public Health, Imperial College London, London, UK; Mohn Centre for Children's Health and Wellbeing, Imperial College London, UK., Bottle A; School of Public Health, Imperial College London, London, UK.
Jazyk: angličtina
Zdroj: Journal of pediatric surgery [J Pediatr Surg] 2024 Dec; Vol. 59 (12), pp. 161694. Date of Electronic Publication: 2024 Aug 20.
DOI: 10.1016/j.jpedsurg.2024.161694
Abstrakt: Background: Little is known about how COVID-19 impacted acute surgical activity for children and young people (CYP) across England. Appendicitis and testicular torsion are common surgical conditions where treatment delays can lead to avoidable complications. We undertook a retrospective national cohort study.
Primary Aim: To describe monthly acute surgical activity in CYP during the COVID-19 pandemic. Secondary aim: To investigate evidence of delayed diagnosis and adverse outcomes, describing variations by age and socioeconomic deprivation.
Methods: Acute hospital admissions with appendicitis or testicular pain for those under 18 were extracted using Hospital Episode Statistics. Interrupted time series modelling, Mann-Whitney and Pearson's Chi-Squared tests compared the first 14 pandemic months with the previous five years. Results were stratified by age (0-4s, 5-9s and 10-17s) and appendicitis type (all, simple and complex).
Results: Admissions for appendicitis and testicular torsion fell significantly early in the COVID-19 pandemic. The proportion of children with complex appendicitis also increased during this time. Orchidectomy rates rose in April 2020 for the 0-4s (+15.6% (95% CI 7.9-23.3)) and 10-17s (+11.5% (4.9-18.2)), but when the pre-pandemic period was compared with the pandemic period as a whole, there were no overall statistically significant differences in orchidectomy rates between the study periods. Overall, there was a statistically significant rise in the orchidopexy rate during the pandemic period for the 10-17s when compared with the pre-pandemic period (Pre-pandemic: 17.0% vs Pandemic: 20.9%, p < 0.0001).
Conclusion: A consistent reduction in activity, with short-lived periods of delayed presentations during COVID-19 pandemic peaks, occurred without persisting overall increased complication rates. These results provide useful national context for smaller sized studies that reported complications due to delays in surgery. Future research could examine how reduced activity impacted other healthcare settings and treatment pathways.
Level of Evidence: II.
(Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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