Impact of the COVID-19 pandemic on pediatric deep neck space infections: Post-pandemic insights from a multi-institutional analysis.

OBJECTIVE: To characterize national trends in infection counts, demographics, management, and healthcare utilization of pediatric deep neck space infections (DNSIs), and evaluate differences across pre-pandemic, pandemic, and post-pandemic periods. METHODS: A retrospective cross-sectional study was conducted using the Pediatric Health Information System (PHIS) database, including children aged 0-18 years diagnosed with parapharyngeal or retropharyngeal abscesses from January 2018 to December 2023. Study intervals were defined as pre-pandemic (2018-2019), pandemic (2020-2021), and post-pandemic (2022-2023). Primary outcomes included infection counts and management trends. Secondary outcomes included length of stay (LOS), hospital charges, and 30-day readmissions. RESULTS: A total of 5334 patients from 49 hospitals were analyzed (median (IQR) age 4 (2- 7) years; 39.2% female). Mean (SD) case volume per hospital decreased during the pandemic (18.3 (13.7) cases) compared with pre-pandemic (41.5 (28.1)) and increased post-pandemic (49.1 (35.2). CT of the neck with contrast was the most common imaging modality, with utilization increasing post-pandemic. Surgical management remained stable across time periods. Antibiotic use was nearly universal, with longer treatment duration during the pandemic. Mean (SD) LOS was higher during the pandemic (3.47 (2.7) days) than pre-pandemic (3.22 (2.2)) or post-pandemic (3.23(2.2)). Mean (SD) hospital charges were highest during the pandemic ($40,485 ($53,720). Thirty-day readmission rates did not differ across study periods. CONCLUSION: The COVID-19 pandemic was associated with reduced DNSI infection counts and modestly prolonged LOS, followed by a post-pandemic rebound exceeding pre-pandemic volumes. These findings highlight the influence of public health measures on pediatric head and neck infections and healthcare utilization.