Management of pediatric appendicitis during the COVID-19 pandemic: A nationwide multicenter cohort study

Brittany Hegde; Elisa Garcia; Andrew Hu; Mehul Raval; Sanyu Takirambudde; Derek Wakeman; Ruth Lewit; Ankush Gosain; Raphael H. Parrado; Robert A. Cina; Krista Stephenson; Melvin S. Dassinger; Daniel Zhang; Moiz M. Mustafa; Donna Koo; Aaron M. Lipskar; Katherine Scheidler; Kyle J. Van Arendonk; Patrick Berg; Raquel Gonzalez; Daniel Scheese; Jeffrey Haynes; Alexander Mina; Irving J. Zamora; Monica E. Lopez; Steven C. Mehl; Elizabeth Gilliam; Katrina Lofberg; Brianna Spencer; Afif N. Kulaylat; Brian C. Gulack; Matthew Johnson; Matthew Laskovy; Pavan Brahmamdam; Aoi Shimomura; Therese Blanch; Kuo Jen Tsao; Bethany J. Slater

doi:10.1016/j.jpedsurg.2022.08.005

Management of pediatric appendicitis during the COVID-19 pandemic: A nationwide multicenter cohort study

Brittany Hegde, Elisa Garcia, Andrew Hu, Mehul Raval, Sanyu Takirambudde, Derek Wakeman, Ruth Lewit, Ankush Gosain, Raphael H. Parrado, Robert A. Cina, Krista Stephenson, Melvin S. Dassinger, Daniel Zhang, Moiz M. Mustafa, Donna Koo, Aaron M. Lipskar, Katherine Scheidler, Kyle J. Van Arendonk, Patrick Berg, Raquel GonzalezDaniel Scheese, Jeffrey Haynes, Alexander Mina, Irving J. Zamora, Monica E. Lopez, Steven C. Mehl, Elizabeth Gilliam, Katrina Lofberg, Brianna Spencer, Afif N. Kulaylat, Brian C. Gulack, Matthew Johnson, Matthew Laskovy, Pavan Brahmamdam, Aoi Shimomura, Therese Blanch, Kuo Jen Tsao, Bethany J. Slater^*

^*Corresponding author for this work

Surgery

Research output: Contribution to journal › Article › peer-review

6 Scopus citations

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.

Original language	English (US)
Pages (from-to)	1375-1382
Number of pages	8
Journal	Journal of pediatric surgery
Volume	58
Issue number	7
DOIs	https://doi.org/10.1016/j.jpedsurg.2022.08.005
State	Published - Jul 2023

Funding

We would like to acknowledge all additional research personnel that assisted with data collection and data entry at all included centers and their contributions to this manuscript. Thomas F. Hamner, BSA, Daniel J. Kim, BS, Claire E. Wilkin, BS. Financial Support Statement: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Keywords

COVID-19
Non-operative management
Patient outcomes
Pediatric appendicitis
SARS-CoV-2
Stay at home order

ASJC Scopus subject areas

Surgery
Pediatrics, Perinatology, and Child Health

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10.1016/j.jpedsurg.2022.08.005

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Hegde, B., Garcia, E., Hu, A., Raval, M., Takirambudde, S., Wakeman, D., Lewit, R., Gosain, A., Parrado, R. H., Cina, R. A., Stephenson, K., Dassinger, M. S., Zhang, D., Mustafa, M. M., Koo, D., Lipskar, A. M., Scheidler, K., Van Arendonk, K. J., Berg, P., ... Slater, B. J. (2023). Management of pediatric appendicitis during the COVID-19 pandemic: A nationwide multicenter cohort study. Journal of pediatric surgery, 58(7), 1375-1382. https://doi.org/10.1016/j.jpedsurg.2022.08.005

@article{76be5c6b990e4e3887744a685c16d4df,

title = "Management of pediatric appendicitis during the COVID-19 pandemic: A nationwide multicenter cohort study",

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.",

keywords = "COVID-19, Non-operative management, Patient outcomes, Pediatric appendicitis, SARS-CoV-2, Stay at home order",

author = "Brittany Hegde and Elisa Garcia and Andrew Hu and Mehul Raval and Sanyu Takirambudde and Derek Wakeman and Ruth Lewit and Ankush Gosain and Parrado, {Raphael H.} and Cina, {Robert A.} and Krista Stephenson and Dassinger, {Melvin S.} and Daniel Zhang and Mustafa, {Moiz M.} and Donna Koo and Lipskar, {Aaron M.} and Katherine Scheidler and {Van Arendonk}, {Kyle J.} and Patrick Berg and Raquel Gonzalez and Daniel Scheese and Jeffrey Haynes and Alexander Mina and Zamora, {Irving J.} and Lopez, {Monica E.} and Mehl, {Steven C.} and Elizabeth Gilliam and Katrina Lofberg and Brianna Spencer and Kulaylat, {Afif N.} and Gulack, {Brian C.} and Matthew Johnson and Matthew Laskovy and Pavan Brahmamdam and Aoi Shimomura and Therese Blanch and Tsao, {Kuo Jen} and Slater, {Bethany J.}",

note = "Publisher Copyright: {\textcopyright} 2022",

year = "2023",

month = jul,

doi = "10.1016/j.jpedsurg.2022.08.005",

language = "English (US)",

volume = "58",

pages = "1375--1382",

journal = "Journal of pediatric surgery",

issn = "0022-3468",

publisher = "W.B. Saunders",

number = "7",

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Hegde, B, Garcia, E, Hu, A, Raval, M, Takirambudde, S, Wakeman, D, Lewit, R, Gosain, A, Parrado, RH, Cina, RA, Stephenson, K, Dassinger, MS, Zhang, D, Mustafa, MM, Koo, D, Lipskar, AM, Scheidler, K, Van Arendonk, KJ, Berg, P, Gonzalez, R, Scheese, D, Haynes, J, Mina, A, Zamora, IJ, Lopez, ME, Mehl, SC, Gilliam, E, Lofberg, K, Spencer, B, Kulaylat, AN, Gulack, BC, Johnson, M, Laskovy, M, Brahmamdam, P, Shimomura, A, Blanch, T, Tsao, KJ & Slater, BJ 2023, 'Management of pediatric appendicitis during the COVID-19 pandemic: A nationwide multicenter cohort study', Journal of pediatric surgery, vol. 58, no. 7, pp. 1375-1382. https://doi.org/10.1016/j.jpedsurg.2022.08.005

TY - JOUR

T1 - Management of pediatric appendicitis during the COVID-19 pandemic

T2 - A nationwide multicenter cohort study

AU - Hegde, Brittany

AU - Garcia, Elisa

AU - Hu, Andrew

AU - Raval, Mehul

AU - Takirambudde, Sanyu

AU - Wakeman, Derek

AU - Lewit, Ruth

AU - Gosain, Ankush

AU - Parrado, Raphael H.

AU - Cina, Robert A.

AU - Stephenson, Krista

AU - Dassinger, Melvin S.

AU - Zhang, Daniel

AU - Mustafa, Moiz M.

AU - Koo, Donna

AU - Lipskar, Aaron M.

AU - Scheidler, Katherine

AU - Van Arendonk, Kyle J.

AU - Berg, Patrick

AU - Gonzalez, Raquel

AU - Scheese, Daniel

AU - Haynes, Jeffrey

AU - Mina, Alexander

AU - Zamora, Irving J.

AU - Lopez, Monica E.

AU - Mehl, Steven C.

AU - Gilliam, Elizabeth

AU - Lofberg, Katrina

AU - Spencer, Brianna

AU - Kulaylat, Afif N.

AU - Gulack, Brian C.

AU - Johnson, Matthew

AU - Laskovy, Matthew

AU - Brahmamdam, Pavan

AU - Shimomura, Aoi

AU - Blanch, Therese

AU - Tsao, Kuo Jen

AU - Slater, Bethany J.

PY - 2023/7

Y1 - 2023/7

N2 - 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.

AB - 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.

KW - COVID-19

KW - Non-operative management

KW - Patient outcomes

KW - Pediatric appendicitis

KW - SARS-CoV-2

KW - Stay at home order

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DO - 10.1016/j.jpedsurg.2022.08.005

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AN - SCOPUS:85137388462

SN - 0022-3468

VL - 58

SP - 1375

EP - 1382

JO - Journal of pediatric surgery

JF - Journal of pediatric surgery

IS - 7

ER -

Management of pediatric appendicitis during the COVID-19 pandemic: A nationwide multicenter cohort study

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