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. 2024 Apr 5;12(4):e5707.
doi: 10.1097/GOX.0000000000005707. eCollection 2024 Apr.

Effects of Sociodemographic and Child Opportunity Index on Pediatric Plastic and Oral and Maxillofacial Surgical Volume Trends in the COVID-19 Pandemic

Kali McCollister  1 , Jay G Berry  2   3   4 , Patrice Melvin  1   5 , Ashley B Tartarilla  1 , Laura C Nuzzi  3 , Debra Lajoie  6 , John G Meara  3   4 , Valerie L Ward  1   4   5   7
Affiliations

Effects of Sociodemographic and Child Opportunity Index on Pediatric Plastic and Oral and Maxillofacial Surgical Volume Trends in the COVID-19 Pandemic

Kali McCollister et al. Plast Reconstr Surg Glob Open. .

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic caused disruptions to pediatric surgical care. Although surgical capacity has returned to the prepandemic state, barriers to surgical access may still exist for children who are medically underserved. We assessed pediatric plastic and oral and maxillofacial surgical volumes by sociodemographic characteristics before and during the COVID-19 pandemic.

Methods: A 72-month retrospective cohort analysis of 10,681 pediatric plastic and oral and maxillofacial procedures between 2016 and 2021 was conducted. Multivariable logistic regression and interrupted time series analyses were used to analyze surgical volume trends by sociodemographic groups and Child Opportunity Index (COI).

Results: Compared with prepandemic, patients undergoing procedures were more likely to be older than 18 years (P < 0.001) and Hispanic/Latino (adjusted odds ratio 1.38; 95% confidence interval, 1.14-1.68; P < 0.01). Surgical volume trends among patients from the lowest COI levels were lower than where they were estimated to have been if the pandemic did not occur (P = 0.040). Patients who spoke a primary language other than English or Spanish (P = 0.02) and patients with the lowest COI levels (P = 0.04) continued to have unrecovered surgical volumes.

Conclusions: There were differences in the sociodemographic case-mix of patients undergoing plastic and oral and maxillofacial surgical procedures before and during the pandemic, and surgical volumes did not recover at the same rate for all patients. Further research can determine why certain sociodemographic groups and patients with low COI levels had decreased surgical access compared with prepandemic trends, and develop interventions focused on equitable pediatric surgical access.

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Conflict of interest statement

Dr. Ward is the Co-Leader of the Health Equity Core and Health Equity Advisor for the Children and Youth with Special Health Care Needs Research Network (CYSHCNet). This program is supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) under UA6MC31101 CYSHCNet. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, and the US Government. Dr. Ward is also a member of the National Project Advisory Committee for a project being conducted by the Institute for Patient- and Family-Centered Care and Cincinnati Children’s Hospital Medical Center funded by the Lucile Packard Foundation for Children’s Health. Dr. Meara is a site Principal Investigator/subrecipient on an NIH grant awarded to Massachusetts General Hospital for a basic science project not related to access to care. The other authors have no financial interest to declare.

Figures

Fig. 1.
Fig. 1.
A graph showing most frequent All Patient-Refined Diagnosis-Related Groups related to plastic surgery encounters.
Fig. 2.
Fig. 2.
A graph showing sociodemographic factors associated with the COVID-19 time frame. Adjusting for all covariates presented. Takes into account individual-level random effects. TF, time frame.
Fig. 3.
Fig. 3.
Time series analysis by COI: A, A graph showing the time series analysis of trends in plastic surgical volumes across prepandemic and pandemic time frames by COI-very low/low. Note: baseline trend P = 0.199; COVID-19 shift P = 0.040. B, A graph showing the time series analysis of trends in plastic surgical volumes across prepandemic and pandemic time frames by COI-very high. Note: Baseline trend P = 0.432; COVID-19 shift P = 0.257.
Fig. 4.
Fig. 4.
Time series analysis by race and ethnicity: A, A graph showing the time series analysis of trends in plastic surgical volumes across prepandemic and pandemic time frames for Asian, non-Hispanic patients. Note: Baseline trend P = 0.548; COVID-19 shift P = 0.387. B, A graph showing the time series analysis of trends in plastic surgical volumes across prepandemic and pandemic time frames for Black, non-Hispanic patients. Note: Baseline trend P = 0.598; COVID-19 shift P = 0.502. C, A graph showing the time series analysis of trends in plastic surgical volumes across prepandemic and pandemic time frames for Hispanic patients. Note: Baseline trend P = 0.199; COVID-19 shift P = 0.377. D, A graph showing the time series analysis of trends in plastic surgical volumes across prepandemic and pandemic time frames for White, non-Hispanic patients. Note: Baseline trend P = 0.774; COVID-19 shift P = 0.377. E, A graph showing the time series analysis of trends in plastic surgical volumes across prepandemic and pandemic time frames for patients of another race and non-Hispanic. Note: Baseline trend P = 0.260; COVID-19 shift P = 0.029.
Fig. 5.
Fig. 5.
Time series analysis by primary language: A, A graph showing the time series analysis of trends in plastic surgical volumes across prepandemic and pandemic time frames for English-speaking patients. Note: Baseline trend P = 0.010; COVID-19 shift P = 0.013. B, A graph showing the time series analysis of trends in plastic surgical volumes across prepandemic and pandemic time frames for Spanish-speaking patients. Note: Baseline trend P = 0.701; COVID-19 shift P = 0.506. C, A graph showing the time series analysis of trends in plastic surgical volumes across prepandemic and pandemic time frames for patients who speak another language other than English or Spanish. Note: Baseline trend P = 0.887; COVID-19 shift P = 0.015.
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