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Postoperative outcomes of pediatric patients with perioperative COVID-19 infection: a systematic review and meta-analysis of observational studies

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Journal of Anesthesia Aims and scope Submit manuscript

A Letter to the Editor to this article was published on 17 November 2023

Abstract

Objective

To quantify the risk of adverse postoperative outcomes in pediatric patients with COVID-19 infection.

Methods

We searched PubMed, Embase, Cochrane Library from December 2019 to 21 April 2023. Observational cohort studies that reported postoperative early mortality and pulmonary complications of pediatric patients with confirmed COVID-19-positive compared with COVID-19-negative were eligible for inclusion. We excluded pediatric patients underwent organ transplantation or cardiac surgery. Reviews, case reports, letters, and editorials were also excluded. We used the Newcastle–Ottawa Scale to assess the methodological quality and risk of bias for each included study. The primary outcome was postoperative early mortality, defined as mortality within 30 days after surgery or during hospitalization. The random-effects model was performed to assess the pooled estimates, which were expressed as risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI).

Results

9 studies involving 23,031 pediatric patients were included, and all studies were rated as high quality. Compared with pediatric patients without COVID-19, pediatric patients with COVID-19 showed a significantly increased risk of postoperative pulmonary complications (PPCs) (RR = 4.24; 95% CI 2.08–8.64). No clear evidence was found for differences in postoperative early mortality (RR = 0.84; 95% CI 0.34–2.06), postoperative intensive care unit (ICU) admission (RR = 0.80; 95% CI 0.39–1.68), and length of hospital stay (MD = 0.35, 95% CI -1.81–2.51) between pediatric patients with and without COVID-19.

Conclusion

Perioperative COVID-19 infection was strongly associated with increased risk of PPCs, but it did not increase the risk of postoperative early mortality, the rate of postoperative ICU admission, and the length of hospital stay in pediatric patients. Our preplanned sensitivity analyses confirmed the robustness of our study findings.

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References

  1. Nepogodiev D, Bhangu A, Glasbey JC, Li E, Omar OM, Simoes JF, Abbott TE, Alser O, Arnaud AP, Bankhead-Kendall BK, Breen KA. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. Lancet. 2020;396(10243):27–38.

    Article  Google Scholar 

  2. Doglietto F, Vezzoli M, Gheza F, Lussardi GL, Domenicucci M, Vecchiarelli L, Zanin L, Saraceno G, Signorini L, Panciani PP, Castelli F, Maroldi R, Rasulo FA, Benvenuti MR, Portolani N, Bonardelli S, Milano G, Casiraghi A, Calza S, Fontanella MM. Factors associated with surgical mortality and complications among patients with and without coronavirus disease 2019 (COVID-19) in Italy. JAMA Surg. 2020;155(8):691–702.

    Article  PubMed  Google Scholar 

  3. Knisely A, Zhou ZN, Wu J, Huang Y, Holcomb K, Melamed A, Advincula AP, Lalwani A, Khoury-Collado F, Tergas AI, Clair CMS. Perioperative morbidity and mortality of patients with COVID-19 who undergo urgent and emergent surgical procedures. Ann Surg. 2021;273(1):34–40.

    Article  PubMed  Google Scholar 

  4. Yates MT, Balmforth D, Lopez-Marco A, Uppal R, Oo AY. Outcomes of patients diagnosed with COVID-19 in the early postoperative period following cardiac surgery. Interact Cardiovasc Thorac Surg. 2020;31(4):483–5.

    Article  PubMed  Google Scholar 

  5. Jonker PK, Van der Plas WY, Steinkamp PJ, Poelstra R, Emous M, Van der Meij W, Thunnissen F, Bierman WF, Struys MM, de Reuver PR, de Vries JPP. Perioperative SARS-CoV-2 infections increase mortality, pulmonary complications, and thromboembolic events: a Dutch, multicenter, matched-cohort clinical study. Surgery. 2021;169(2):264–74.

    Article  PubMed  Google Scholar 

  6. Lei S, Jiang F, Su W, Chen C, Chen J, Mei W, Zhan LY, Jia Y, Zhang L, Liu D, Xia ZY. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. EClinicalMedicine. 2020;21:100331.

    Article  PubMed  PubMed Central  Google Scholar 

  7. American Society of Anesthesiologists and Anesthesia Patient Safety Foundation Joint Statement on Elective Surgery and Anesthesia for Patients after COVID-19 Infection. https://www.apsf.org/news-updates/asa-and-apsf-joint-statement-on-elective-surgery-and-anesthesia-for-patients-after-covid-19-infection/.

  8. 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(13):1239–42.

    Article  CAS  PubMed  Google Scholar 

  9. Bunyavanich S, Do A, Vicencio A. Nasal gene expression of angiotensin-converting enzyme 2 in children and adults. JAMA. 2020;323(23):2427–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Mehl SC, Loera JM, Shah SR, Vogel AM, Fallon SC, Glover CD, Monson LA, Enochs JA, Hollier LH, Lopez ME. Favorable postoperative outcomes for children with COVID-19 infection undergoing surgical intervention: experience at a free-standing children’s hospital. J Pediatr Surg. 2021;56(11):2078–85.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Nepogodiev D. Favourable perioperative outcomes for children with SARS-CoV-2. Br J Surg. 2020;107(13):e644–5.

    CAS  PubMed  Google Scholar 

  12. Masoudian P, Sullivan KJ, Mohamed H, Nasr A. Optimal timing for inguinal hernia repair in premature infants: a systematic review and meta-analysis. J Pediatr Surg. 2019;54(8):1539–45.

    Article  PubMed  Google Scholar 

  13. Hu A, Reiter AJ, Gerardo R, Skertich NJ, Lewit R, Ghani M, Witte A, Kang HS, Richards H, Perry B, Tian Y. Association between COVID-19 related elective surgery cancellations and pediatric inguinal hernia complications: a nationwide multicenter cohort study. Surgery. 2022;172(3):989–96.

    Article  PubMed  Google Scholar 

  14. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Wells GA, Shea B, D O'Connell JP, Welch ML, P Tugwell. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. https://www.ohri.ca/programs/clinical_epidemiology/oxford.asp

  16. Salluh JI, Wang H, Schneider EB, Nagaraja N, Yenokyan G, Damluji A, Serafim RB, Stevens RD. Outcome of delirium in critically ill patients: systematic review and meta-analysis. BMJ. 2015;350:h2538.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Damuth E, Mitchell JA, Bartock JL, Roberts BW, Trzeciak S. Long-term survival of critically ill patients treated with prolonged mechanical ventilation: a systematic review and meta-analysis. Lancet Respir Med. 2015;3(7):544–53.

    Article  PubMed  Google Scholar 

  18. Cumpston M, Li T, Page MJ, Chandler J, Welch VA, Higgins JP, Thomas J. Updated guidance for trusted systematic reviews: a new edition of the cochrane handbook for systematic reviews of interventions. Cochrane Database Syst Rev. 2019;10:ED000142.

    PubMed  Google Scholar 

  19. Nielson C, Taylor I, Huang Y, Park AH. Surgical outcomes in pediatric patients testing positive for SARS-CoV-2. J Am Coll Surg. 2021;233(5):e153.

    Article  PubMed Central  Google Scholar 

  20. Nielson C, Suarez D, Taylor IK, Huang Y, Park AH. Surgical outcomes inchildren with perioperative SARS-CoV-2 diagnosis. Am J Infect Control. 2022;50(6):602–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Saynhalath R, Alex G, Efune PN, Szmuk P, Zhu H, Sanford EL. Anesthetic complications associated with severe acute respiratory syndrome coronavirus 2 in pediatric patients. Anesth Analg. 2021;133(2):483–90.

    Article  CAS  PubMed  Google Scholar 

  22. Geng-Ramos G, Nelson J, Lee AC, Deutsch N, Challa C, Pestieau S, Rana MS, Hubbard M, Cronin JA. Postanesthesia complications in pediatric patients with previous SARS-CoV-2 infection: a cohort study. Paediatr Anaesth. 2023;33(1):79–85.

    Article  PubMed  Google Scholar 

  23. Cronin JA, Nelson JH, Farquhar I, Braffett B, Bebu I, Pestieau SR, Geng-Ramos G, Heitmiller E, Deutsch N. Anesthetic outcomes in pediatric patients with COVID-19: a matched cohort study. Paediatr Anaesth. 2021;31(6):733–5.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Peterson MB, Gurnaney HG, Disma N, Matava C, Jagannathan N, Stein ML, Liu H, Kovatsis PG, von Ungern-Sternberg BS, Fiadjoe JE, PAWS‐COVID‐19 Group. Complications associated with paediatric airway management during the COVID-19 pandemic: an international, multicentre, observational study. Anaesthesia. 2022;77(6):649–58.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Prajapati S, Choudhury SR, Aditya M, Maheshwari A, Anirudha AJ, Sarin YK. Magnitude of SARS-CoV-2 infection and outcome in paediatric surgical inpatients during the first wave of pandemic at a tertiary care Children’s hospital in India. J Trop Pediatr. 2022;68(2):fmac011.

    Article  PubMed  Google Scholar 

  26. Giwangkancana G, Oktaliansah E, Ramlan AAW, Utariani A, Kurniyanta P, Arifin H, Widyastuti Y, Pratiwi A, Syukur R. Perioperative management for emergency surgery in pediatric patients with COVID-19: retrospective observational study. Open Access Emerg Med. 2022;14:515–24.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Glasbey J. Peri-operative outcomes of surgery in children with SARS-CoV-2 infection. Anaesthesia. 2022;77(1):108–9.

    Article  CAS  PubMed  Google Scholar 

  28. Price JC, Lee JJ, Ing C, Li G, Narula J, Clark MK, Stylianos S, Whittington RA, Levy RJ, Sun LS. Prevalence of SARS-CoV-2 positivity in pediatric surgical patients amid the first wave of the COVID-19 pandemic in New York City. J Neurosurg Anesthesiol. 2022;34(1):132–5.

    Article  PubMed  Google Scholar 

  29. Senanayake KJ. Mortality of emergency abdominal surgery in high-, middle- and low-income countries. Br J Surg. 2016;103(8):971–88.

    Article  Google Scholar 

  30. Castagnoli R, Votto M, Licari A, Brambilla I, Bruno R, Perlini S, Rovida F, Baldanti F, Marseglia GL. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children and adolescents: a systematic review. JAMA Pediatr. 2020;174(9):882–9.

    Article  PubMed  Google Scholar 

  31. Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr. 2020;109(6):1088–95.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Li B, Zhang S, Zhang R, Chen X, Wang Y, Zhu C. Epidemiological and clinical characteristics of COVID-19 in children: a systematic review and meta-analysis. Front Pediatr. 2020;2(8):591132.

    Article  Google Scholar 

  33. Bailey LC, Razzaghi H, Burrows EK, Bunnell HT, Camacho PE, Christakis DA, Eckrich D, Kitzmiller M, Lin SM, Magnusen BC, Newland J. Assessment of 135 794 pediatric patients tested for severe acute respiratory syndrome coronavirus 2 across the United States. JAMA Pediatr. 2021;175(2):176–84.

    Article  PubMed  Google Scholar 

  34. Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, Tong S. Epidemiology of COVID-19 among children in China. Pediatrics. 2020. https://doi.org/10.1542/peds.2020-0702.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Simon AK, Hollander GA, McMichael A. Evolution of the immune system in humans from infancy to old age. Proc Biol Sci. 1821;2015(282):20143085.

    Google Scholar 

  36. Wrapp D, Wang N, Corbett KS, Goldsmith JA, Hsieh CL, Abiona O, Graham BS, McLellan JS. Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation. Science. 2020;367(6483):1260–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Chung M, Bernheim A, Mei X, Zhang N, Huang M, Zeng X, Cui J, Xu W, Yang Y, Fayad ZA, Jacobi A. CT imaging features of 2019 novel coronavirus (2019-nCoV). Radiology. 2020;295(1):202–7.

    Article  PubMed  Google Scholar 

  38. Chen A, Huang JX, Liao Y, Liu Z, Chen D, Yang C, Yang RM, Wei X. Differences in clinical and imaging presentation of pediatric patients with COVID-19 in comparison with adults. Radiol Cardiothorac Imaging. 2020;2(2):e200117.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Egbuta C, Mason KP. Recognizing risks and optimizing perioperative care to reduce respiratory complications in the pediatric patient. J Clin Med. 2020;9(6):1942.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Zhang S, Ding S, Cai M, Bai J, Zhang M, Huang Y, Zheng J. Impact of upper respiratory tract infections on perioperative outcomes of children undergoing therapeutic cardiac catheterisation. Acta Anaesthesiol Scand. 2018;62(7):915–23.

    Article  CAS  PubMed  Google Scholar 

  41. Lee LK, Bernardo M, Grogan TR, Elashoff DA, Ren W. Perioperative respiratory adverse event risk assessment in children with upper respiratory tract infection: validation of the COLDS score. Paediatr Anaesth. 2018;28(11):1007–14.

    Article  PubMed  Google Scholar 

  42. von Ungern-Sternberg BS, Boda K, Schwab C, Sims C, Johnson C, Habre W. Laryngeal mask airway is associated with an increased incidence of adverse respiratory events in children with recent upper respiratory tract infections. Anesthesiology. 2007;107(5):714–9.

    Article  Google Scholar 

  43. von Ungern-Sternberg BS, Boda K, Chambers NA, Rebmann C, Johnson C, Sly PD, Habre W. Risk assessment for respiratory complications in paediatric anaesthesia: a prospective cohort study. Lancet. 2010;376(9743):773–83.

    Article  Google Scholar 

  44. Reiter AJ, Ingram MC, Raval MV, Garcia E, Hill M, Aranda A, Chandler NM, Gonzalez R, Born K, Mack S, Lamoshi A. Postoperative respiratory complications in SARS-CoV-2 positive pediatric patients across 20 United States hospitals: a cohort study. J Pediatr Surg. 2022. (In press)

  45. Lobo D, Devys JM. Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study. Anaesthesia. 2022;77(1):110.

    Article  CAS  PubMed  Google Scholar 

  46. Leventoğlu ÖKKEŞ. Delaying surgery for patients with a previous SARS-CoV-2 infection. Br J Surg. 2020;107(12):e601–2.

    Article  Google Scholar 

  47. Lee DR, Banik GL, Giordano T, Kazahaya K, Lin EE. Early elective surgery in children with mild COVID-19 does not increase pulmonary complications: a retrospective cohort study. Paediatr Anaesth. 2022;32(10):1172–4.

    Article  PubMed  Google Scholar 

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Funding

All phases of this study were supported by Science & Technology Department of Sichuan Province (No. 2023NSFSC1626).

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Authors and Affiliations

  1. Department of Anesthesiology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Qingyang District, Chengdu, 611731, China

    Tianqing Gong, Qinghua Huang, Qianqian Zhang & Yu Cui

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  1. Tianqing Gong
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  2. Qinghua Huang
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Contributions

Conceptualization, methodology, formal analysis were performed by TG. Investigation and data curation were performed by QH and QZ. Supervision, writing-review and editing were performed by YC. The first draft of the manuscript was written by TG and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Yu Cui.

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Gong, T., Huang, Q., Zhang, Q. et al. Postoperative outcomes of pediatric patients with perioperative COVID-19 infection: a systematic review and meta-analysis of observational studies. J Anesth 38, 125–135 (2024). https://doi.org/10.1007/s00540-023-03272-7

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