Organizational aspects of pediatric anesthesia and surgery between two waves of Covid‐19

• DOI: 10.1111/aas.13802
• Publication Date: 2021-02-23T07:34:54Z
• Authors: Anna Camporesi; Giorgio E. M. Mel...; Veronica Diotto; Patrizia Bertani; Enrico La Pergola; Gloria Pelizzo
• Keywords: Adolescent; Covid-19; healthcare workers' safety; patient safety; pediatric anesthesia; pediatric surgery; Cohort Studies; Hospitals, University; Appointments and Schedules; 03 medical and health sciences; Hospitals, Urban; 0302 clinical medicine; Humans; Child; Diagnosis-Related Groups; Infant, Newborn; COVID-19; Infant; Hospitals, Pediatric; 3. Good health; Caregivers; Elective Surgical Procedures; Hospital Bed Capacity; COVID-19 Nucleic Acid Testing; Child, Preschool; Female; Emergencies; Anesthesia Department, Hospital

BackgroundThe initial wave of the Covid‐19 pandemic has hit Italy, and Lombardy in particular, with violence, forcing to reshape all hospitals' activities; this happened even in pediatric hospitals, although the young population seemed initially spared from the disease. “Vittore Buzzi” Children's Hospital, which is a pediatric/maternal hospital located in Milan (Lombardy Region), had to stop elective procedures—with the exception of urgent/emergent ones—between February and May 2020 to leave space and resources to adults' care. We describe the challenges of reshaping the hospital's identity and structure, and restarting pediatric surgery and anesthesia, from May on, in the most hit area of the world, with the purpose to avoid and contain infections. Both patients and caregivers admitted to hospital have been tested for Sars‐CoV‐2 in every case.MethodsObservational cohort study via review of clinical charts of patients undergoing surgery between 16th May and 30th September 2020, together with SARS‐CoV ‐2 RT‐PCR testing outcomes, and comparison to same period surgeries in 2019.ResultsAn increase of approximately 70% in pediatric surgeries (OR 1.68 [1.33‐2.13], P < .001) and a higher increase in the number of surgeries were reported (OR 1.75 (1.43‐2.15), P < .001). Considering only urgent procedures, a significant difference in the distribution of the type of surgery was observed (Chi‐squared P‐value < .001). Sars‐CoV‐2‐positive patients have been 0.8% of total number; 14% of these was discovered through caregiver's positivity.ConclusionWe describe our pathway for safe pediatric surgery and anesthesia and the importance of testing both patient and caregiver.