Evaluation of the Pandemic Normalization Process in Pediatric Surgery Operations: Tertiary Center Experience

Abstract

Objectives: The aim of this study was to evaluate pandemicinormalization process in pediatric surgery operations. Methods: This was a retrospective study conducted at a tertiary center. In our study, 917 individuals were included. It was defined as the period between June 2020, when normalization was announced after the first wave of the Coronavirusidisease-19 (COVID-19) pandemic in our country, and November 2020, when the second wave of measures began [Group 1 (n=393,42.7%)]. One year later was defined as the second period [Group 2 (n=525, 57.3%)], corresponding to the same time period (June 2021-November 2021). Results: The median age of Group 1 was 5 years and Group 2 was 6 years (p <0.001). Emergency surgery was more common in Group 2 (31.1% vs 35.4%). General anesthesia is the most commonly perfomed anesthesia method in both groups (98.5% vs 97.3%). Abdominal operations were the most common in both groups (48% vs 49%). While the rate of laparoscopic surgery was 62% in Group 1, it was 62.1% in Group 2. A statistically significant difference was detected in preoperative COVID-19 polymeraseichain reaction (PCR) test examination Group 2 and postoperative COVID-19 PCR test examination Group 1. Lymphocyte and C-reactive protein (CRP) serum markers were similar between groups. There was no difference between the need for intensive care unit/postanesthesia care unit and mortality rates. Conclusion: Although the number of pediatric surgical operations decreased during the normalization period, a successful process was managed in terms of the quality and results of the cases.

Keywords

• COVID-19
• pandemicinormalization process
• pediatric surgery

Pediatrik Cerrahi Operasyonlarında Pandemik Normalleşme Sürecinin Değerlendirilmesi: Üçüncü Basamak Merkez Deneyimi

Abstract

Amaç: Bu çalışmanın amacı pediatrik cerrahi operasyonlarında pandemi normalizasyon sürecini değerlendirmektir.ediatrik cerrahi operasyonlarında pandemik normalleşme sürecinin değer-lendirilmesi: Üçüncü basamak merkez deneyimi Materyal ve Metod: Bu, üçüncü basamak bir merkezde yürütülen retrospektif kesitsel ve karşılaştırmalı çalışmadır. Çalışmamıza 917 kişi dahil edildi. Ülkemizde COVID-19 salgınının ilk dal-gasının ardından normalleşmenin açıklandığı Haziran 2020 ile ikinci önlem dalgasının başladığı Kasım 2020 arasındaki dönem olarak tanımlandı [Grup 1 (n= 393,42.7%)]. Bir yıl sonra, aynı zaman dilimine (Haziran 2021-Kasım 2021) karşılık gelen ikinci dönem [Grup 2 (n=525, %57,3)] olarak tanımlandı. Bulgular: Grup 1'in ortanca yaşı 5, Grup 2'nin ortanca yaşı 6 idi (p<0,001). Acil ameliyatlar Grup 2'de daha sık görüldü (%31,1'e karşı %35,4). Genel anestezi her iki grupta da en sık uygulanan anestezi yöntemidir (%98,5'e karşı %97,3). Her iki grupta da en sık batın ameliyatları yapıldı (%48'e karşı %49). Laparoskopik cerrahi uygulanma oranı Grup 1'de %62 iken Grup 2'de %62,1 oldu. Ameliyat öncesi COVID-19 polimeraz zincir reaksiyonu (PCR) test incelemesi Grup 2’de ve ameliyat sonrası COVID-19 PCR test incelemesi Grup 1'de istatistiksel olarak anlamlı fark tespit edildi. Lenfosit ve C-reaktif protein (CRP) serum belirteçleri gruplar arasında benzerdi. Yoğun bakım ünitesi/anestezi sonrası bakım ünitesi ihtiyacı ile ölüm oranları arasında fark yoktu. Sonuç: Normalleşme sürecinde pediatrik cerrahi operasyonlarının sayısı azalsa da vakaların kalitesi ve sonuçları açısından başarılı bir süreç yönetildi.

Keywords

• COVID-19
• pandemi normalizasyon süreci
• pediatrik cerrahi

References

1. 1. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Nov-el Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020 Mar;323(11):1061–9.
2. 2. Stokes EK, Zambrano LD, Anderson KN, Marder EP, Raz KM, Felix S, et al. Coronavirus Disease 2019 Case Surveillance - United States, January 22-May 30, 2020. MMWR Morb Mor-tal Wkly Rep. 2020;69(24):759-765.
3. 3. Kim L, Whitaker M, O’Halloran A, Kambhampati A, Chai S, Reingold A, et al. Hospitalization Rates and Characteristics of Children Aged <18 Years Hospitalized with Laboratory-Confirmed COVID-19 - COVID-NET, 14 States, March 1-July 25, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(32):1081-1088.
4. 4. Sağlık Bakanlığı Elektif İşlemlerin Ertelenmesi ve Diğer Alınacak Tedbirler. 2020;:8–9.
5. 5. Park P, Laverde R, Klazura G, Yap A, Bvulani B, Ki B, et al. Impact of the COVID-19 Pandemic on Pediatric Surgical Vol-ume in Four Low- and Middle-Income Country Hospitals: In-sights from an Interrupted Time Series Analysis. World J Surg. 2022 May;46(5):984–93.
6. 6. Melander S, Almström J, Enlund G, Frykholm P. The COVID-19 pandemic first wave in Sweden: A national registry study of the effects on pediatric anesthesia and surgery. Paediatr Anaesth. 2021 Aug;31(8):846–53.
7. 7. Fu MZ, Islam R, Singer EA, Tabakin AL. The Impact of COVID-19 on Surgical Training and Education. Cancers (Ba-sel). 2023 Feb;15(4).
8. 8. Cappelleri G, Fanelli A, Ghisi D, Russo G, Giorgi A, Torrano V, et al. The Role of Regional Anesthesia During the SARS-CoV2 Pandemic: Appraisal of Clinical, Pharmacological and Organizational Aspects. Front Pharmacol. 2021;12:574091.

9. 9. Krikri A, Alexopoulos V, Zoumakis E, Katsaronis P, Balafas E, Kouraklis G, et al. Laparoscopic vs. open abdominal surgery in male pigs: marked differences in cortisol and catechola-mine response depending on the size of surgical incision. Hormones (Athens). 2013;12(2):283–91.
10. 10. Siekmann W, Eintrei C, Magnuson A, Sjölander A, Matthies-sen P, Myrelid P, et al. Surgical and not analgesic technique affects postoperative inflammation following colorectal cancer surgery: a prospective, randomized study. Color Dis Off J Assoc Coloproctology Gt Britain Irel. 2017 Jun;19(6):O186–95.
11. 11. Goel P, Basu AK. Laparoscopy during the COVID-19 Pandem-ic: Absence of Evidence is not Evidence of Absence. J Indian Assoc Pediatr Surg. 2020;25(4):195–200.
12. 12. Prasad NK, Lake R, Englum BR, Turner DJ, Siddiqui T, Mayorga-Carlin M, et al. Increased complications in patients who test COVID-19 positive after elective surgery and im-plications for pre and postoperative screening. Am J Surg. 2022 Feb;223(2):380–7.
13. 13. Jackson WM, Price JC, Eisler L, Sun LS, Lee JJ. COVID-19 in Pediatric Patients: A Systematic Review. J Neurosurg Anes-thesiol. 2022 Jan;34(1):141–7.
14. 14. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet (London, England). 2020;395(10223): 497–506.
15. 15. Toba N, Gupta S, Ali AY, ElSaban M, Khamis AH, Ho SB, et al. COVID-19 under 19: A meta-analysis. Pediatr Pulmonol. 2021 Jun;56(6):1332–41.
16. 16. Qi K, Zeng W, Ye M, Zheng L, Song C, Hu S, et al. Clinical, laboratory, and imaging features of pediatric COVID-19: A systematic review and meta-analysis. Medicine (Balti-more). 2021 Apr;100(15):e25230.