Projects

Ab s trac t Objective: The coronavirus disease 2019 (COVID-19) pandemic has resulted in many alterations in the management of surgical patients. We share our experience with surgical emergencies during the COVID-19 pandemic and their subsequent 3-year follow-up. Materials and methods: This observational study was conducted over 1 year. Demographic details, diagnosis, surgery, COVID-19 test results, inflammatory markers, days of hospital stay, and complications were collated from inpatient files, discharge summaries, and outpatient records. The follow-up data were collected by reviewing outpatient cards and conducting telephonic interviews. Results: A total of 70 children underwent emergency procedures. The age ranged from 0 to 17 years, and 60% were males. COVID-19 testing was done as per the institution’s protocol. Around 27.1% were COVID-19 positive and underwent laparotomy, peritoneal dialysis catheter insertion, ventriculoperitoneal shunt revision, and central line insertions. Bowel gangrene secondary to vascular thrombosis in one child and burst abdomen following pyloromyotomy in another child were unique pathologies that could be attributable to COVID-19. The average hospital stay was 10.1 ± 5.5 days. The remaining 51 children underwent mostly laparotomy, endoscopy, and bronchoscopy. Conclusion: Surgical pathology dictates outcome in COVID-19-positive children. Vascular thrombosis-induced complications may be of concern but are amenable to timely intervention. Routine screening and following universal protocols ensure collateral protection. The use of prophylactic antibiotics and anticoagulants in COVID-19-positive surgical children needs validation in larger cohorts. Keywords: Coronavirus disease 2019, Emergency, Outcome, Pediatric surgery, Thrombosis. The outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was declared a pandemic by the World Health Organization on 11th March 2020.1 This resulted in various modifications in the management of surgical patients, particularly aimed at decreasing aerosol generation and curtailing the inflammatory cascade. Reports on the management of COVID-19-infected pediatric surgical patients are few. Here, we present our experience in treating COVID-19 pediatric surgical emergencies (suspect and positive), highlighting the outcomes and the follow-up. Mat eria l s a n d Me t h o d s This is an observational study of children admitted for pediatric surgical services in a tertiary care hospital in India during the COVID-19 pandemic, from April 2020 to April 2021. The inclusion criteria for this study were children of age-group 0–18 years who required surgical intervention and who were COVID-19 rapid antigen positive or real-time reverse transcriptase-polymerase chain reaction (RT-PCR) positive. The data was sourced from admission records, discharge summaries, and outpatient records. Where follow-up in person was not feasible, telephonic communication was opted for. Demographics, primary diagnosis, surgery/intervention, COVID-19 test results (rapid antigen test/reverse transcription polymerase chain reaction, rapid antigen test (RAT)/(RT-PCR), inflammatory markers [ferritin, C-reactive protein (CRP), D-dimer], days of hospital stay, complications, and follow-up were recorded. The review excluded COVID-19-positive children requiring elective surgeries, for whom it was postponed by at least 3 months. Children with semi-elective pathologies (like pelviureteric junction obstruction, undescended testis, etc.), wherein surgery was done after 2 weeks following a COVID-19-negative report were also excluded. The study was approved by the Institutional Ethics Committee (IEC-316/2021). Data were tabulated with continuous variables reported as mean and standard deviation (SD) for normally distributed variables or as median and interquartile range for those not normally distributed. Categorical variables were reported using numbers and percentages.