International Journal of Pediatric Otorhinolaryngology ( IF 1.5 ) Pub Date : 2021-09-13 , DOI: 10.1016/j.ijporl.2021.110923 Ashley M Lloyd 1 , Hengameh K Behzadpour 2 , Habib G Zalzal 2 , Ishwarya S Mamidi 3 , Hannah R Crowder 3 , Claire M Lawlor 2 , Diego Preciado 2 , Brian K Reilly 2
Objective
The novel coronavirus (COVID-19) forced unprecedented changes in pediatric otolaryngology workflow in the early pandemic, particularly due to the postponement of elective procedures. In turn, this has impacted timely treatment of patients and ability to train residents and fellows. The objective is to characterize how surgical practices in pediatric otolaryngology have been impacted by the pandemic through a cross sectional analysis over three years.
Methods
This cross-sectional study focuses on patients who underwent surgical procedures within the department of otolaryngology at a single tertiary pediatric hospital. Descriptive statistical analysis was used to compare subsets of patients from pre-pandemic in 2019, early-pandemic in 2020, and late-pandemic in 2021.
Results
Operative volume decreased by 87.57% in the early pandemic and 36.86% in the late pandemic. In the early pandemic, the greatest decreases were seen in airway reconstruction (100%), adenotonsillectomy (96.4%), adenoidectomy (94.7%), myringotomy with tympanostomy tube insertion (94.6%), frenulectomy (94.1%), and sinonasal procedures (93.3%), while in the late-pandemic adenotonsillectomy (42.4%) and myringotomy with tympanostomy tube insertion (70.1%) remained reduced when compared to pre-pandemic volume. Increased average case lengths in the early-pandemic (78.28 ± 51.95 min) and late-pandemic (71.91 ± 70.76 min) were observed when compared to pre-pandemic (52.26 ± 39.20 min) (p < 0.001). An increased proportion of multidisciplinary cases were completed in 2020 and 2021 (p < 0.001). In the 2020, 25% of cases were completed without trainee involvement. There was an overall decrease in case numbers for trainees and increase in cases without their involvement when compared to 2019 and 2021.
Conclusion
The COVID-19 pandemic resulted in a decrease in pediatric otolaryngology surgical procedures, particularly at the onset of the pandemic. While surgical trainees saw a dramatic reduction in case numbers early on, one year into the pandemic case volume is increasing and trending to pre-pandemic numbers. More complex cases, as represented by patients requiring longer operative times, inpatient status, and more frequently multidisciplinary care, were seen in the early pandemic, while drastic reductions were seen in routine outpatient procedures.
中文翻译:
新型冠状病毒对三级儿科医院手术实践的影响:一项为期 3 年的横断面研究
客观的
新型冠状病毒 (COVID-19) 在大流行早期迫使儿科耳鼻喉科工作流程发生了前所未有的变化,特别是由于择期手术的推迟。反过来,这影响了患者的及时治疗以及培训住院医生和研究员的能力。目的是通过三年的横断面分析来描述小儿耳鼻喉科手术实践如何受到大流行的影响。
方法
这项横断面研究的重点是在一家三级儿科医院的耳鼻喉科接受外科手术的患者。描述性统计分析用于比较 2019 年大流行前、2020 年大流行早期和 2021 年大流行晚期的患者亚群。
结果
手术量在大流行早期下降了 87.57%,在大流行晚期下降了 36.86%。在大流行早期,减少最多的是气道重建 (100%)、腺样体扁桃体切除术 (96.4%)、腺样体切除术 (94.7%)、鼓膜切开术和鼓室置管术 (94.6%)、系带切除术 (94.1%) 和鼻窦手术 ( 93.3%),而与大流行前相比,大流行晚期腺样体扁桃体切除术(42.4%)和鼓膜切开术与鼓室管插入术(70.1%)仍然减少。与大流行前(52.26 ± 39.20 分钟)相比,观察到大流行早期(78.28 ± 51.95 分钟)和大流行晚期(71.91 ± 70.76 分钟)的平均病例长度增加(p < 0.001)。2020 年和 2021 年完成的多学科病例比例增加(p < 0.001)。2020年,25% 的案例是在没有受训人员参与的情况下完成的。与 2019 年和 2021 年相比,受训人员的案件数量总体减少,而没有他们参与的案件数量增加。
结论
COVID-19 大流行导致儿科耳鼻喉科手术减少,尤其是在大流行开始时。虽然外科实习生在早期发现病例数急剧减少,但进入大流行病一年后病例数正在增加,并趋向于大流行前的数字。在大流行早期出现了更复杂的病例,例如需要更长手术时间、住院状态和更频繁的多学科护理的患者,而在常规门诊手术中出现了大幅减少。