Elective Pediatric Surgery in 1350 COVID-Positive Children: A Multiyear National Surgical Quality Improvement Program - Pediatric Analysis of 30-Day Outcomes.

INTRODUCTION Uncertainty persists regarding perioperative risk and scheduling recommendations for children with recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We aimed to determine whether preoperative COVID-19 status was associated with adverse perioperative outcomes for elective pediatric surgery procedures.

Methods

An analysis of American College of Surgeons National Surgical Quality Improvement Program - Pediatric data was performed for elective operations performed under general anesthesia between 2021 and 2024. Preoperative COVID-positive status was the exposure of interest. The primary outcome was 30-day composite morbidity (respiratory, cardiovascular, renal, neurologic, hemorrhagic, thrombotic, or infectious complications). Secondary outcomes included 30-day unplanned readmission, reoperation, and mortality. COVID-positive patients were propensity-matched at 1:1 ration to COVID-negative patients using demographic, comorbidity, procedural, and surgical complexity variables. Outcomes were compared between groups.

Results

Among 412,710 eligible cases, 1350 (0.3%) had preoperative COVID-19. Prior to matching, COVID-positive patients demonstrated greater medical complexity and underwent higher- relative value units procedures. After matching (1348 pairs), baseline characteristics were well balanced. There was no significant difference in 30-day composite morbidity between COVID-positive and matched COVID-negative patients (9.0% versus 8.2%, P = 0.478). COVID-positive patients experienced higher rates of prolonged ventilator dependence (>48 h; 4.5% versus 3.0%, P = 0.038) and unplanned 30-day readmission (7.1% versus 5.0%, P = 0.028). There were no differences in reoperation or mortality.

Conclusions

In children undergoing elective surgery, preoperative SARS-CoV-2 infection was not associated with a clinically meaningful increase in overall 30-day perioperative morbidity after adjustment for case mix and comorbidity. Although prolonged ventilator dependence and unplanned readmission were statistically more frequent among COVID-positive patients, the absolute differences were small.