The COVID-19 pandemic first wave in Sweden: A national registry study of the effects on pediatric anesthesia and surgery

Abstract

Background: The COVID-19 pandemic is pushing healthcare systems to their limits. Dramatic reductions in the adult elective surgery are ubiquitous, but corresponding changes in pediatric services are not well described. The Swedish Perioperative Registry contains data on all anesthetic procedures in Sweden, and therefore, provides a unique opportunity to analyze the effect of the pandemic on the pediatric anesthesia capacity on a national level. We hypothesized that there would be a significant reduction in pediatric elective procedures. The aim was to determine the effects on pediatric surgical and anesthetic services during the first wave of the COVID-19 pandemic in Sweden.

Methods: For this retrospective registry cohort study, we extracted all procedures performed on patients <18 years of age in 2020 and 2019. Weeks 12 to 26 of 2020 were defined as the first wave, and data were analyzed according to level of care, type of surgery, procedure code, and emergency or elective surgery.

Results: We found 7015 fewer procedures during the first wave epoch. Elective cases were reduced by 53.7% while emergency surgery was not significantly affected. During the peak of the first wave in April, there was a 72.8% reduction in elective cases; ENT/maxillofacial surgery showed the greatest reduction (86.7%). The surgical and anesthesia capacity recovered to near-normal levels by the end of June 2020.

Conclusion: We conclude that the impact of COVID-19 on pediatric surgical procedures in Sweden during the first wave of the pandemic was dramatic, but elective services were restored a few months after the peak.

Keywords: COVID-19; general surgery; orthopedic surgery; pediatric hospitals; workload.

FIGURE 1

Number of performed anesthetics for the ten most common procedures in 2019 (y‐axis), comparing 2020 and 2019 during the first wave of the pandemic, in this paper encompassing 14 weeks from March 15 to June 27. Arm X—arm fracture. Diagnostic examination includes some nonoperating room procedures. *p < .05, **p < .001

FIGURE 2

Percentage reductions in caseload during the first wave of the pandemic (y‐axis), in this paper encompassing 14 weeks from March 16 to June 28 (week 12, starting March 16th—week 26, starting June 22, ISO standard week numbers on the x‐axis). General surgery and orthopedic surgery were less severely affected than ENT/maxillofacial surgery and urologic surgery

FIGURE 3

Percentage reduction in caseload during the spring and summer weeks of 2020 in university hospitals, county hospitals, and district hospitals (left y‐axis). This graph includes several weeks before and after the epoch that was analyzed as the “first wave” in this paper, illustrating how the latter started in week 12 (the third week of March, starting March 16), peaked in week 15 (the second week of April, starting April 6) and ended after week 26 (ISO standard week numbers on the x‐axis). The bars represent the weekly total number of positive COVID‐19 tests in Sweden (right y‐axis), data from the Public Health Agency

FIGURE 4

Weekly death rate in COVID‐19 in Sweden and weekly total number of COVID‐19 patients in intensive care on the y‐axis (including adult and pediatric patients), the x‐axis shows the ISO standard week number. Week 15, starting April 6 was the peak week. Data from the Public Health Agency and the Swedish Intensive Care Registry, [Colour figure can be viewed at wileyonlinelibrary.com]