Favorable Postoperative Outcomes for Children with COVID-19 Infection Undergoing Surgical Intervention: Experience at a Free-Standing Children's Hospital

Mehl, Steven C.; Loera, Jackquelin M.; Shah, Sohail R.; Vogel, Adam M.; Fallon, Sara C.; Glover, Chris D.; Monson, Laura A.; Enochs, Joyce A.; Hollier, Larry H.; Lopez, Monica E.

BACKGROUND: Current literature has shown that adult patients with perioperative Coronavirus Disease-2019 (COVID-19) have increased rates of postoperative morbidity and mortality. We hypothesized that children with COVID-19 have favorable postoperative outcomes compared to the reported adult experience. METHODS: We performed a retrospective cohort study for children with a confirmed preoperative COVID-19 diagnosis from April 1(st), 2020 to August 15(th), 2020 at a free-standing children's hospital. Primary outcomes evaluated were postoperative complications, readmissions, reoperations, and mortality within 30 days of operation. Secondary outcomes included hospital resource utilization, hospital length of stay, and postoperative oxygen support. RESULTS: A total of 66 children with preoperative confirmed COVID-19 were evaluated with median age of 9.5 years (interquartile range (IQR) 5-14) with 65% male and 70% Hispanic White. Sixty-five percent of patients had no comorbidities, with abdominal pain identified as the most common preoperative symptom (65%). Twenty-three percent of patients presented with no COVID-19 related symptoms. Eighty-two percent of patients had no preoperative chest imaging and 98% of patients did not receive preoperative oxygen support. General pediatric surgeons performed the majority of procedures (68%) with the most common diagnosis appendicitis (47%). Forty-one percent of patients were discharged the same day as surgery with 9% of patients utilizing postoperative intensive care unit resources and only 5% receiving postoperative invasive mechanical ventilation. Postoperative complications (7%), readmission (6%), and reoperation (6%) were infrequent, with no mortality. CONCLUSION: COVID-19+ children requiring surgery have a favorable postoperative course and short-term outcomes compared to the reported adult experience. TYPE OF STUDY: Prognosis Study. LEVEL OF EVIDENCE: Level IV.