Characterization of initial North American pediatric surgical response to the COVID-19 pandemic

Abstract

Introduction: The impact of COVID-19 pandemic on pediatric surgical care systems is unknown. We present an initial evaluation of self-reported pediatric surgical policy changes from hospitals across North America.

Methods: On March 30, 2020, an online open access, data gathering spreadsheet was made available to pediatric surgeons through the American Pediatric Surgical Association (APSA) website, which captured information surrounding COVID-19 related policy changes. Responses from the first month of the pandemic were collected. Open-ended responses were evaluated and categorized into themes and descriptive statistics were performed to identify areas of consensus.

Results: Responses from 38 hospitals were evaluated. Policy changes relating to three domains of program structure and care processes were identified: internal structure, clinical workflow, and COVID-19 safety/prevention. Interhospital consensus was high for reducing in-hospital staffing, limiting clinical fellow exposure, implementing telehealth for conducting outpatient clinical visits, and using universal precautions for trauma. Heterogeneity in practices existed for scheduling procedures, implementing testing protocols, and regulating use of personal protective equipment.

Conclusions: The COVID-19 pandemic has induced significant upheaval in the usual processes of pediatric surgical care. While policies evolve, additional research is needed to determine the effect of these changes on patient and healthcare delivery outcomes.

Level of evidence: III.

Keywords: COVID-19 response; Disaster management; Disaster response; Pandemic; Pediatric surgery; Surgical quality and safety.

Fig. 1

Variance in date of site update and date of state's predicted surge. *Predicted surge date source (accessed 4/16/20): https://covid19.healthdata.org/united-states-of-america. Responses from 38 programs regarding changes in hospital guidelines and procedures related to care of pediatric surgical patients in the COVID-19 pandemic. The relationship of dates of last update for the open access document relative to the respective state's predicted date of COVID-19 surge are shown.

Fig. 2

(A–C) Number of changes by days until predicted COVID-19 surge. Group 1 hospitals updated results within 10 days of predicted surge date, Group 2 updated within 11–20 days of predicted surge, and Group 3 updated within 21–30 days of predicted surge date.