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Postoperative Respiratory Complications in SARS-CoV-2 Positive Pediatric Patients Across 20 United States Hospitals: A Cohort Study.

Authors :
Reiter AJ
Ingram ME
Raval MV
Garcia E
Hill M
Aranda A
Chandler NM
Gonzalez R
Born K
Mack S
Lamoshi A
Lipskar AM
Han XY
Fialkowski E
Spencer B
Kulaylat AN
Barde A
Shah AN
Adoumie M
Gross E
Mehl SC
Lopez ME
Polcz V
Mustafa MM
Gander JW
Sullivan TM
Sulkowski JP
Ghani O
Huang EY
Rothstein D
Muenks EP
St Peter SD
Fisher JC
Levy-Lambert D
Reichl A
Ignacio RC
Slater BJ
Tsao K
Berman L
Source :
Journal of pediatric surgery [J Pediatr Surg] 2023 Aug; Vol. 58 (8), pp. 1543-1549. Date of Electronic Publication: 2022 Nov 03.
Publication Year :
2023

Abstract

Introduction: Data examining rates of postoperative complications among SARS-CoV-2 positive children are limited. The purpose of this study was to evaluate the impact of symptomatic and asymptomatic SARS-CoV-2 positive status on postoperative respiratory outcomes for children.<br />Methods: This retrospective cohort study included SARS-CoV-2 positive pediatric patients across 20 hospitals who underwent general anesthesia from March to October 2020. The primary outcome was frequency of postoperative respiratory complications, including: high-flow nasal cannula/non invasive ventilation, reintubation, pneumonia, Extracorporeal Membrane Oxygenation (ECMO), and 30-day respiratory-related readmissions or emergency department (ED) visits. Univariate analyses were used to evaluate associations between patient and procedure characteristics and stratified analyses by symptoms were performed examining incidence of complications.<br />Results: Of 266 SARS-CoV-2 positive patients, 163 (61.7%) were male, and the median age was 10 years (interquartile range 4-14). The majority of procedures were emergent or urgent (n = 214, 80.5%). The most common procedures were appendectomies (n = 78, 29.3%) and fracture repairs (n = 40,15.0%). 13 patients (4.9%) had preoperative symptoms including cough or dyspnea. 26 patients (9.8%) had postoperative respiratory complications, including 15 requiring high-flow oxygen, 8 with pneumonia, 4 requiring non invasive ventilation, 3 respiratory ED visits, and 2 respiratory readmissions. Respiratory complications were more common among symptomatic patients than asymptomatic patients (30.8% vs. 8.7%, p = 0.01). Higher ASA class and comorbidities were also associated with postoperative respiratory complications.<br />Conclusions: Postoperative respiratory complications are less common in asymptomatic versus symptomatic SARS-COV-2 positive children. Relaxation of COVID-19-related restrictions for time-sensitive, non urgent procedures in selected asymptomatic patients may be reasonably considered. Additionally, further research is needed to evaluate the costs and benefits of routine testing for asymptomatic patients.<br />Level of Evidence: Iii, Respiratory complications.<br /> (Copyright © 2022 Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1531-5037
Volume :
58
Issue :
8
Database :
MEDLINE
Journal :
Journal of pediatric surgery
Publication Type :
Academic Journal
Accession number :
36428183
Full Text :
https://doi.org/10.1016/j.jpedsurg.2022.10.048