Asemptomatik Olgularda COVID-19 Prevalansı ve Acil ve Ertelenemeyen Cerrahi Planlanan Çocuklarda Komplikasyon Gelişimine Etkisi

Year 2021, Volume: 15 Issue: 5, 415 - 419, 23.09.2021

Müjdem Azılı , Can Öztorun , Elif Emel Erten , Doğuş Güney , Ahmet Ertürk , Gülsen Keskin , Ayşe Ertoy , Abdurrahman Urve Uzun , Süleyman Arif Bostancı , Aslınur Özkaya Parlakay , Emrah Şenel

https://doi.org/10.12956/tchd.983312

Abstract

Amaç: Çocukluklarda COVID-19 sıklıkla asemptomatik ya da daha selim bir seyre sahip olsa da temas riskinden dolayı sağlık çalışanlarının güvenliği asıl hedef olmalıdır. Çalışmamızda hem hasta hem ameliyathane hem de sağlık çalışanlarının iş güvenliğine ışık tutacak acil ve ertelenemeyen cerrahi olgularında asemptomatik COVID-19 PCR pozitifliğini araştırmayı amaçladık.

Gereç ve Yöntemler: Çalışmamız pandemi hastanesine dahil çocuk hastanesinin çocuk cerrahisi kliniğine acil ve ertelenemeyen cerrahi nedenler ile başvuran 18 yaş altı olgular için tasarlanmış olup ileriye dönük yapılmış tek merkezli bir çalışmadır. Çalışmaya Mayıs 2020 -Ekim 2020 tarihleri arası altı aylık izlemde acil ve ertelenemeyen cerrahi yapılan olgular dahil edildi. Belirtilen tarihler arasında başvuran 458 hasta değerlendirildi ve kriterleri karşılayan 433 hasta çalışma kapsamında değerlendirildi. olgulardan preoperatif muayene ve tetkik esnasında COVID-19 için nazofaringeal sürüntü (PCR) örneği alındı.

Bulgular: Çalışmaya dahil edilen 433 olgunun 155’i kız (%33.5), 278’i (%66.5) erkekti. Yaş ortalaması 9.5 yıl olarak hesaplandı. Acil vakaların tüm olguların 389’unu (%89.8) oluşturduğu saptandı. Yaş gruplarına göre en sık acil patolojilerin; yenidoğan döneminde intestinal obstrüksiyon veya atreziler, okul öncesi dönemde solunum yoluna yabancı cisim aspirasyonlar, okul çağında akut apandisit olduğu görüldü. Nazal sürüntü PCR sonuçları sadece dört hastada pozitif bulundu, bu oranın tüm çalışma grubunda %0.9 olduğu görüldü, bu olguların hiçbirinde postoperatif komplikasyon ve sağlık çalışanına bulaş saptanmadı.

Sonuç: Bu prospektif çalışma ile acil veya ertelenemeyen cerrahi planlanan asemptomatik çocuklarda düşük COVID-19 PCR pozitifliği (%0.9 prevalans) tespit edilmiş olup güvenli prosedür uygulamalarının planlanmasına ışık tutacağı kanaatindeyiz.

Keywords

COVID-19, Cerrahi, PCR, Komplikasyon, Asemptomatik

The Prevalence of COVID-19 in Asymptomatic Cases and Its Effect on Complication Development in Children Scheduled for Emergency and Urgent Surgery

Abstract

Objective: Although COVID-19 in childhood is often asymptomatic or has a more benign course, the safety of healthcare workers should be the primary goal because of the risk of contamination. In our study, we aimed to investigate the asymptomatic COVID-19 PCR positivity and its effect on the development of complications in emergency and non-deferred surgery cases that will help both the patient, the operating room and the health care workers.

Material and Methods: This is a prospective study that was performed in patients under 18 years of age who were operated on due to emergency and urgent cases in the Ankara City Children’s Hospital, which was serving as an anti-pandemic hospital. The patients were evaluated from May 1 to October 1, 2020. Of the 458 patients, 433 patients who met the criteria were included in the study. COVID-19 Nasopharyngeal swab (PCR) samples were taken from all patients along with preoperative examinations.

Results: Of the 433 cases included in the study, 155 (33.5%) were girls and 278 (66.5%) were boys. It was determined that emergency cases constituted 389 (89.8%) of all cases. The most common emergency pathologies according to age groups were intestinal obstruction or atresia in the neonatal period, foreign body aspirations of the respiratory tract in the preschool period, and acute appendicitis in the school age. Nasal swab PCR results were positive in only four patients, this rate was found to be 0.9% in the entire study group, and postoperative complications and transmission to healthcare workers were detected at none.

Conclusion: In this prospective study, low COVID-19 PCR positivity (0.9% prevalence) was detected in asymptomatic children scheduled for emergency or non-deferred surgery, and we believe that it will shed light on the planning of safe procedure practices.

Keywords

Covid 19, surgey, PCR, Complication, Asymptomatic

References

• Dedeilia A, Esagian SM, Ziogas IA, Giannis D, Katsaros I, Tsoulfas G. Pediatric surgery during the COVID-19 pandemic. World J Clin Pediatr 2020;9:7-16.
• Saxena AK. SARS-CoV-2 pandemic and pediatric endoscopic surgery. Springer 2020;2:51-3.
• Azılı MN, Şenel E. Management of Trauma And Surgical Procedures in Children During The COVID-19 Pandemic. Türkiye Çocuk Hast Derg 2020;14(COVID-19):72-5.
• Singer JS, Cheng EM, Murad DA, Maurice AdS, Hines OJ, Uslan DZ, et al. Low prevalence (0.13%) of COVID-19 infection in asymptomatic pre-operative/pre-procedure patients at a large, academic medical center informs approaches to perioperative care. Surgery 2020;168:980-6.
• Lin EE, Blumberg TJ, Adler AC, Fazal FZ, Talwar D, Ellingsen K, et al. Incidence of COVID-19 in pediatric surgical patients among 3 US children’s hospitals. JAMA surgery 2020;155:775-7.
• Nepogodiev D, Bhangu A, Glasbey JC, Li E, Omar OM, Simoes JF, et al. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. The Lancet 2020;396:27-38.
• Robbins E, Ilahi Z, Roth P. Febrile infant: COVID-19 in addition to the usual suspects. Pediatr Infect Dis J 2020;39:e81-e2.
• Nepogodiev D. Favourable perioperative outcomes for children with SARS-CoV-2. Journal of British Surgery 2020;107:e644-e5.
• Gomez Ochoa SA, Franco OH, ROJAS LZ, Raguindin PF, Roa Diaz ZM, Wyssamnn BM et al. COVID-19 in Health-Care Workers: A Living Systematic Review and Meta-Analysis of Prevalence, Risk Factors, Clinical Characteristics, and Outcomes. Am J Epidemiol 2021;190:161-75.
• Yang Y, Lu Q, Liu M, Wang Y, Zhang A, Jalali N, et al. Epidemiological and clinical features of the 2019 novel coronavirus outbreak in China. medrxiv. 2020. doi.org/10.1101/2020.02.10.20021675.
• Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. Jama 2020;323:1239-42.
• Jiatong S, Wenjun L. Epidemiological characteristics and prevention and control measures of Corona Virus Disease 2019 in children. J Trop Med 2020;20:153‐6.