The impact of the COVID-19 pandemic on presentation of surgical disease in paediatric patients at a tertiary centre in Cape Town, South Africa

Abstract

Background: Children are less susceptible to infection with SARS-CoV-2 and subsequent severe disease, yet especially vulnerable to the  indirect effects of the pandemic. A constrained healthcare service, combined with the societal and behavioural changes observed during  the pandemic, is likely to have altered the presentation of paediatric surgical disease. The objective was to investigate the impact of the  COVID-19 pandemic on the volume of paediatric surgical admissions, the severity of disease and the type of surgical pathology treated at our centre.

Methods: A retrospective cohort study compared paediatric surgical admissions in an eleven-month period before COVID-19 to the same  period during the pandemic. Comparisons in volume and diagnoses were based on the number of admissions. Predetermined criteria for  severity of disease using triage scores, intraoperative findings and intensive care admissions were compared.

Results: A total of 1 810  admissions were recorded, 1061 in the pre-COVID group and 749 during COVID. Emergency admissions reduced by 9.2%, most  notably due to a reduction in trauma, caustic ingestions and constipation. There was an increase in incarcerated inguinal hernias and  helminth-related pathologies. Significantly more intussusceptions failed pneumatic reduction requiring surgical intervention with bowel  resection. There was a two-fold increase in patients requiring emergency intensive care.

Conclusion: Paediatric surgical volumes at our  centre decreased during the COVID-19 pandemic. There was evidence of more advanced disease on presentation of inguinal hernias and  intussusception and a generalised increased demand for  emergency ICU admission.