COVID-19 impact on operative management of pediatric neck abscesses

Introduction: For multiple reasons, elective pediatric otolaryngology surgical procedures have declined during the COVID-19 pandemic. However, it is less clear how COVID- 19 has affect acute care surgeries. The purpose of this study was to assess whether the prevalence of pediatric head or neck abscesses managed with operative drainage decreased compared with previous years. Method: In a retrospective study, we evaluated medical records of 203 pediatric cases diagnosed with abscess of the head or neck and treated with incision and drainage at a large tertiary care children's hospital between the dates of April 1 and November 30 from 2015 to 2020. We compared outcomes for each year from 2015 with 2019 with the same date range in 2020, which included location of the infection, abscess size, symptoms, duration of antibiotic treatment before and after operative intervention, microbiology, and the number of cases per year. Results: The mean ± SD presenting age in the 2015-2019 group was 5.10 ± 5.10 years and 2.24 ± 1.91 years in the 2020 group. Neck abscesses were more common than head abscesses from 2015 to 2019 (81.7% vs 18.3%), whereas only neck abscesses presented in 2020 (P = .030). The mean number of cases between 2015 and 2019 was 36 ± 3.81, whereas the number of cases in 2020 was 23 (P = .036). The most common symptom was neck stiffness or swelling in both groups (2015-2019, 74.4% vs 2020, 100%, P = .003). Of those patients who underwent intravenous antibiotic therapy prior to presentation (n = 43), the mean number of days before admission was 1.98 ± 2.95 (n = 40) from 2015 to 2019 and 12.00 ± 10.39 (n = 3) in 2020 (P = .008). The percentage of cases with multiple strains cultured between 2015 and 2019 was 13.8% vs 18.2% in (P = .007). Conclusion: There was a decrease in the number of operative head or neck abscesses in 2020 during the COVID-19 pandemic compared with the mean number per year from 2015 to 2019 within the same date range. COVID-19 mitigation strategies leading to reduced transmission of other viral and bacterial illnesses and a tendency toward prolonged medical management to avoid surgery during the pandemic are 2 possible reasons for this decrease.