Paediatric Surgery and Associated Mortality in England: A Nationwide Epidemiological Study.

Abstract

Background: Delays to NHS surgical care have been widespread during and after the pandemic, but the impact on children is poorly described. Methods: Observational cohort study using National Health Service (NHS) hospital data in England describing children aged <18 years undergoing surgery between 1st April 2015 and 31st December 2020, with supplementary data until March 2023. The primary outcome was mortality within 90 days after surgery. The secondary outcome was hospital stay. We report trends in annual surgical procedure volume and mortality. Frequencies presented as n(%). Findings: We identified 36,605,870 surgical procedures, between 1st April 2015 and 31st December 2020, of which 1,846,965 (5·0%) were for children. 759,083/1,846,965 (41·1%) patients were female and 313,981 (17·0%) were from minority ethnic groups. There were 41,018/1,846,965 (2·2%) procedures among neonates, 93,872 (5·1%) for children aged 28 days to one year, 532,828 (28·8%) for years 1-5, 502,971 (27·2%) for years 5-12, 361,176 (19·6%) for years 12-15, and 315,100 (17·1%) for years 15-17. The median hospital stay was 1 (0-1) day. There were 6,573/1,846,965 (0·36%) deaths within 90 days after surgery, and mortality rates changed little over the study period including during the pandemic. The average annual number of procedures before the pandemic (2015-2019) was 340,596, decreasing to 266,049 in 2023, representing a 22% reduction in procedure volume. Interpretation: One in 14 NHS surgical procedures are performed on children, with substantially lower mortality than adults. Procedure volume decreased by one-fifth during and after the pandemic while mortality remained unchanged. These data suggest surgery for children could safely continue during future similar pandemics.