Should Elective Surgical Procedures Be Delayed in Pediatric Cases in Covid-19 Pandemic? Until When? Is Pcr Required in The Preoperative Period? (original) (raw)
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Safety of elective paediatric surgery during the coronavirus disease 2019 pandemic
International Journal of Pediatric Otorhinolaryngology, 2021
Corona-virus Disease 2019 (COVID-19) has had a huge impact on the delivery of healthcare worldwide, particularly elective surgery. There is a lack of data regarding risk of postoperative COVID-19 infection in children undergoing elective surgery, and regarding the utility of pre-operative COVID-19 testing, and preoperative "cocooning" or restriction of movements. The purpose of this present study was to examine the safety of elective paediatric Otolaryngology surgery during the COVID-19 pandemic with respect to incidence of postoperative symptomatic COVID-19 infection or major respiratory complications. Materials and methods: Prospective cohort study of paediatric patients undergoing elective Otolaryngology surgery between September and December 2020. Primary outcome measure was incidence of symptomatic COVID-19 or major respiratory complications within the 14 days after surgery. Parents of prospectively enrolled patients were contacted 14 days after surgery and enquiry made regarding development of postoperative symptoms, COVID-19 testing, or diagnosis of COVID-19. Results: 302 patients were recruited. 125 (41.4%) underwent preoperative COVID-19 RT-PCR testing. 66 (21.8%) restricted movements prior to surgery. The peak 14-day COVID-19 incidence during the study was 302.9 cases per 100,000 population. No COVID-19 infections or major respiratory complications were reported in the 14 day follow-up period. Conclusion: The results of our study support the safety of elective paediatric Otolaryngology surgery during the pandemic, in the setting of community incidence not exceeding that observed during the study period.
Screening for COVID-19 in Children Undergoing Elective Invasive Procedures
Indian Journal of Pediatrics
Objective To report the frequency of asymptomatic infection with SARS-CoV-2 in pediatric patients undergoing invasive medical procedures in a tertiary pediatric hospital. Methods From June to October 2020, a SARS-CoV-2 real-time reverse-transcription polymerase chain reaction (rRT-PCR) test was performed for all pediatric patients scheduled to undergo an elective invasive procedure. None of the patients was symptomatic. The cycle threshold (Ct) values of the ORF1ab gene were recorded for all patients. Results A total of 700 patients were screened for SARS-CoV-2 infection. The median age was 5.7 y old. In total, 46.6% (n = 326) of the patients were male, and 53.4% (n = 374) were female. The most common underlying diseases were hematooncological (25.3%), gastrointestinal (24.9%), and genitourinary (10.3%). The main scheduled surgical-medical procedures were surgical treatment for acquired congenital diseases, biopsy sampling, local therapy administration, organ transplantation, and the placement of central venous catheters, among others. The SARS-CoV-2 rRT-PCR test was positive in 9.4% (66), and the median Ct value was 35.8. None of the patients developed COVID-19. Conclusions The frequency of asymptomatic SARS-CoV-2 infection was detected in less than 10% of pediatric patients scheduled to undergo an elective invasive procedure in a tertiary hospital. This frequency is higher than those in reports from different countries.
Infectio
Background: COVID-19 has changed medical practice nowadays. One of the biggest concerns has been establishing when invasive procedures such as surgery, GI endoscopy or bone marrow transplant are safe; and if it is necessary to consider screening for asymptomatic patients. Methods: We identified asymptomatic patients that were scheduled for invasive procedures from May 2020 to April 2021 at Clínica de Marly. Patients were asked to fill a questionnaire about GI and upper respiratory symptoms and contact with possible/confirmed cases of COVID- 19 in the last 15 days. Patients taken to emergency procedures, who had symptoms or contact with probable/confirmed cases in the last 15 days were excluded. rt-PCR was performed to screen COVID-19. Results: A total of 1837 patients were included. 104 rt-PCRs tested positive for SARS-CoV-2, leading to a 5.66% of identified asymptomatic patients. Patients were followed-up on the 30th day after the procedure. 1733 negative patients responded to our ...
Hospital Practice
Objectives: Many hospitals have recently instituted policies mandating preoperative COVID-19 testing. However, it is uncertain whether institutions can dictate such policies based on infection rates found in the general population. Therefore, the main aims of the study were to determine (1) what proportion of preoperative patients tested positive, (2) what percentage was asymptomatic, and (3) whether variations throughout time in numbers of positive patients reflected changes observed in our state. Methods: All COVID-19 preoperative screening tests (nasopharyngeal-swab RT-PCR testing) performed in our hospital between 04/13/2020 and 08/27/2020 were retrospectively reviewed. The unit of analysis was number of patients who tested negative/positive. Medical records of positive patients were reviewed to determine the presence of COVID-19 symptoms. A curve was created showing our number of positive patients per week and another one presenting the number of positive patients per day in Florida, both figures were compared. Results: A total of 7,213 patients from all specialties were preoperatively tested, out of which 85 were positive for an overall infection rate of 1.2%. In 18% (15/85) of positive patients, it was not possible to determine symptomatology. Among remaining patients, 49% (34/70) were asymptomatic while 51% (36/70) were symptomatic for COVID-19. Peak of positive cases occurred in mid-July in both curves, and the upward and downward tendencies in positive numbers mirrored each other. Conclusion: COVID-19 infection rate among our preoperative patients was very low. Nearly 50% of positive patients were asymptomatic. Our data suggest that a tertiary hospital can promulgate COVID-19 preoperative screening policies based on infection trends observed in the general population. However, in addition to the test, patients should be encouraged to self-quarantine for 14 days before surgery.
Open Access Emergency Medicine
Background: The first wave of COVID-19 in 2020 created massive challenges in providing safe surgery for pediatric patients with COVID-19. Inevitably, emergency surgery and the unknown nature of the disease place a burden on the heavily challenged surgical services for pediatrics in a developing country. Lessons from the pandemic are important for future disaster planning. Aim: To describe the characteristics of pediatric surgical patients with COVID-19 undergoing emergency surgery during the first wave and its perioperative narrative in a developing country. Methods: The study was a multicenter retrospective descriptive study in eight Indonesian government-owned referral and teaching hospitals. The authors reviewed confirmed COVID-19 pediatric patients (≤18 years old) who underwent surgery. Institutional review board clearances were acquired, and data were evaluated in proportion and percentages. The writing of this paper follows the STROBE guidelines. Results: About 7791 pediatric surgical cases were collected, 73 matched the study criteria and 24 confirmed cases were found. Cases were more common in females (58.3%), who were above 12 years old (37.5%) and who were asymptomatic (62.5%). Laparotomy (33.3%), general anesthesia (90.4%) and intubation (80.8%) were common, while use of video laryngoscopy (40%) and rapid sequence intubation (28.8%) were rare. The mean length of stay was 12 ±13.3 days, and in-hospital mortality was 8.3%. Discussions: Lockdown and school closure were successful in protecting children, hence the low incidence of pediatric surgical cases with COVID-19 during the first wave. Many hospitals were unprepared to perform surgery for a droplet or airborne infectious disease, and COVID-19 testing was not available nationally in the early pandemic, hence the use of protective protection equipment during these early pandemic times are often not efficient. Conclusion: The incidence of COVID-19 in pediatric surgical patients is low. The rapidity and availability of preoperative testing for a new emerging disease are essential in a pandemic.
Current Pediatric Research, 2021
Introduction: COVID-19 pandemic had a significant impact on the pediatric and neonatal surgery. The COVID-19 infection in children present either with mild symptoms or with atypical clinical features mimicking other infectious diseases. This study was conducted to assess the impact of COVID-19 pandemic and lockdown on the pediatric surgical cases admitted and managed at our Institute. Materials and Methods: Clinical characteristics and management & its outcome were noted down. Clinical characteristics included age, weight, gender, residence, nature of disease, any past history of surgery, history of contact with COVID patient, any recent COVID infection. These variables were compared with the patients managed during pre-COVID-19 era of same duration. All the babies admitted for routine and some emergency cases where tested for COVID-19 using RT-PCR method. COVID tests were done post-operatively in emergency cases. Results: During the study 630 patients were admitted and managed in our department, which included 200 elective, 150 semi emergencies, and 280 emergency cases. The average age was 19.53 ± 23 months. The study included 190 surgical neonates also. There were 400 male and 230 female patients. A total of 20 patients were tested positive during the study period. Among these 20 patients, 12 were tested positive on preoperative screening, while as eight cases were positive on post-operative COVID testing. Operation theatre days were reduced from 6 days to 4 days per week. The several measures undertaken in the outpatient clinic, operation theatre, pre and post-operative period to minimize the spread of COVID-19 virus from child to caregiver and surgical staff were highly effective. During these 9 months five doctors in our department got infected, with mild to moderate symptoms of COVID 19. They resumed their duties after an average of 2 to 3 weeks. Our academic activities got significantly hampered, although bedside teaching and case discussions continued in wards and operation theatres. Conclusion: COVID-19 pandemic effects pediatric population also, surgeries and the concern for its transmission. We continue to perform routine neonatal and pediatric surgical cases, while adapting the standard safety protocols. We believe that health professionals who use the appropriate personal protective equipment may continue to work in outpatient and operating rooms.
Impact of asymptomatic COVID-19 patients in global surgical practice during the COVID-19 pandemic
British Journal of Surgery, 2020
Impact of asymptomatic COVID-19 patients in global surgical practice during the COVID-19 pandemic Editor The rapid spread of COVID-19 has changed the global surgical care 1-3. Patients infected with COVID-19 may present without typical symptoms, and such asymptomatic patients may potentially trigger in-hospital outbreaks by transmitting the disease to health care providers and other hospitalized patients 4, 5. Further, asymptomatic COVID-19 patients have worse postoperative outcomes with an unexpectedly Table 1 Preoperatively asymptomatic COVID-19 patients by the countries' risk group Countries by risk group Overall High risk Int. risk Low risk 936 330 242 364 P Value Testing policies before surgery. No. (%) a * Vittoria Bellato and Tsuyoshi Konishi contributed equally to this work as the co-first authors. Contributors of 'S-COVID Collaborative Group' are listed in Supporting Information.
Preoperative Screening for COVID-19: Results from a Clinical Diagnostic Laboratory
Experimed, 2022
Objective: The study aimed to determine what proportion of Turkiye's preoperative patient population has tested positive for COVID-19 and to ascertain whether the increasing or decreasing trend in the numbers of positive preoperative patients resembles the general population of Turkiye during the same period. Materials and Methods: The study cohort involved of the 14,776 patients from various services between January 1-December 31, 2021 who needed preoperative COVID-19 test reports. The patient's SARS-CoV-2 RNA's were detected with real-time polymerase chain reaction (RT-PCR) technique. Results: SARS-CoV-2 RT-PCR positivity was detected in 422 (2.86%) patients, of which 59.72% (n = 252) were female and 40.28% (n = 170) were male; their mean age was 40.2 years. Of the 422 positive cases, 84.12% were young adults (18-65 years), and 9% were middle-aged (66-79 years). Positive cases involving those under the age of 18 were found to account for 5.22% (n = 22) of the total. The highest positivity rate was observed in April 2021 at 8.28% of all test requests, while the lowest positivity rate was observed in June 2021, at 0.36% of all test requests. The highest positivity rate of April was followed by March (5.07%), October (4.74%), and August (3.13%). Conclusion: In conclusion, the COVID-19 RT-PCR positivity rate in the series was detected as 2.85% in preoperative patients over the oneyear period. Monthly positivity rates in screening results are consistent with the number of cases seen in the general population.