The safety of paediatric surgery between COVID-19 surges: an observational study.

In what is likely to be a protracted global pandemic, there is a need to develop an evidence base to guide re-initiation and continuation of elective paediatric surgery, as well as robust decision making surrounding non-elective surgery where risk benefit ratios must be carefully evaluated.


This study sought to describe perioperative patient outcomes in a single centre after re-initiating paediatric elective surgery following the first wave of COVID-19, and to evaluate the measures used to detect COVID-19 positive patients in their surgical population during this period.


Observational cohort study performed in a single paediatric hospital in North West of England, a region with the highest COVID-19 prevalence in the country at that time.

The study comprised 2 phases, cohorts were compared with surgical patients treated in the same time period in 2019.

Phase 1: retrospective analysis of urgent and emergent paediatric surgical cases done during the UK lockdown. Emergent surgical cases underwent rapid nucleic acid testing (results awaited before proceeding if clinical urgency allowed).

Phase 2: prospective data collection after recommencement of elective surgeries. During this phase, patients completed a combination of 14 days self-isolation, exposure risk screening questionnaire, and mandatory SARS-CoV-2 testing 72 hours before surgery. Those with low risk on screening and a negative swab proceeded to elective surgery.


  • During the COVID-19 lockdown, 49.7% of children undergoing surgery underwent perioperative testing for COVID-19. Of these, 5/373 (1.3%) tested positive for the virus. The positive status was unknown at the time of anaesthesia in 4/5 of these cases.
  • During phase 2 of the study, there was no difference in length of stay, unplanned critical care admission, 14-day hospital re-admission for the patients undergoing elective surgery, as compared to the pre-COVID era during 2019. There were no patients diagnosed with COVID-19 on repeat postoperative testing.
  • There was a 2.9% COVID related cancellation rate for elective surgeries during phase 2.

Take home messages

  • This is a reasonably good quality observational study that seeks to address important questions regarding the safety of recommencement of elective surgeries during the ongoing COVID-19 pandemic.
  • At this single centre, a combination of preoperative 14-day isolation, risk screening questionnaire, and COVID-19 testing allowed elective surgeries to continue without an increase in adverse perioperative outcomes, or inadvertent elective operation on paediatric patients that were COVID-19 positive.
  • However, extrapolation of findings to other centres is limited by likely regional variations in community prevalence of COVID-19 and its various strains, different local nucleic acid testing, and variation in local population adherence to preoperative isolation instruction.

Reviewed by Heather Patterson