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. 2023 Aug;58(8):1543-1549.
doi: 10.1016/j.jpedsurg.2022.10.048. Epub 2022 Nov 3.

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

Audra J Reiter  1 , Martha-Conley E Ingram  2 , Mehul V Raval  2 , Elisa Garcia  3 , Madelyn Hill  4 , Arturo Aranda  4 , Nicole M Chandler  5 , Raquel Gonzalez  5 , Kristen Born  6 , Shale Mack  6 , Abdulraouf Lamoshi  7 , Aaron M Lipskar  7 , Xiao-Yue Han  8 , Elizabeth Fialkowski  8 , Brianna Spencer  9 , Afif N Kulaylat  9 , Amrene Barde  10 , Ami N Shah  10 , Maeva Adoumie  11 , Erica Gross  11 , Steven C Mehl  12 , Monica E Lopez  13 , Valerie Polcz  14 , Moiz M Mustafa  14 , Jeffrey W Gander  15 , Travis M Sullivan  16 , Jason P Sulkowski  16 , Owais Ghani  13 , Eunice Y Huang  13 , David Rothstein  17 , E Peter Muenks  18 , Shawn D St Peter  18 , Jason C Fisher  19 , Dina Levy-Lambert  19 , Allison Reichl  20 , Romeo C Ignacio  20 , Bethany J Slater  21 , KuoJen Tsao  3 , Loren Berman  6
Affiliations

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

Audra J Reiter et al. J Pediatr Surg. 2023 Aug.

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.

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.

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.

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.

Level of evidence: Iii, Respiratory complications.

Keywords: COVID-19; Pediatric surgery; Respiratory complications.

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Figures

Fig 1
Fig. 1
Data flow to demonstrate sources of missing data.
Fig 2
Fig. 2
Number of days between positive SARS-CoV-2 test and procedure among children undergoing general anesthesia.
See this image and copyright information in PMC

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