Impact of COVID-19 on demographic trends and predictors of surgical interventions in pediatric orbital cellulitis

Purpose To evaluate the COVID-19 pandemic’s impact on the presentation patterns, severity, and predictors of surgical intervention in pediatric orbital cellulitis.Methods Electronic medical records of patients with orbital cellulitis presenting to Texas Children’s Hospital in Houston, Texas between 2012 and 2023 were reviewed. Multivariable logistic regression identified predictors of subperiosteal abscess (SPA) occurrence and need for surgical intervention within three months, including endoscopic sinus surgery (ESS) and orbitotomy, for the full cohort and post-pandemic subgroups.Results In total, 389 patients were included (209 pre-pandemic, 180 post-pandemic). Average age was 7.6 ± 4.4 years, with 63.8% male, 65.3% White, and 35.0% Hispanic/Latino. After pandemic onset, monthly presentation rates increased from 2.13 to 3.91 cases/month (p < 0.001), while SPA occurrence declined from 75.12% to 66.11%. No significant changes in patient age, sex, race/ethnicity, or BMI were observed. Interaction models showed generally stable predictors of SPA, ESS, and orbitotomy. Superior SPA location was the only consistent predictor across all surgical outcomes.Conclusions The COVID-19 pandemic was associated with increased pediatric orbital cellulitis presentations but not changes in demographic or clinical severity indicators. Superior SPA location and patient age remain key predictors of surgical complexity and need for repeat intervention.