BACKGROUND AND OBJECTIVES: Historically, cholecystectomy was infrequently performed in children. Lifestyle changes, delays in health care access, and increases in childhood obesity occurred during the COVID-19 pandemic. The impact of these shifts on need for cholecystectomy are poorly understood. We evaluate trends in cholecystectomy case volume among children during the COVID-19 pandemic. METHODS: A multi-institutional retrospective cohort study was conducted for children ages 18 years and younger who underwent cholecystectomy from January 1, 2016, to July 31, 2022, at 10 children's hospitals. Differences in cholecystectomy case mix and volume before and during the pandemic were identified using bivariate comparisons and interrupted time series analysis. RESULTS: Overall, 4282 children were identified: 2122 before the pandemic and 2160 during the pandemic. Most were female (74.2%) with a median age of 15 years (IQR, 13.0-16.0 years). The proportion of Hispanic (55.0% vs 60.1%
P = .01) patients, body mass index (BMI) (26.0 vs 27.1
P <
.001), and obesity (BMI >
30) (30.8% vs 37.4%
P <
.001) increased during the pandemic. Predicted monthly case volume increased from 40 to 100 during the pandemic. Patients transferred from an outside hospital increased (21.3% vs 28.5%
P <
.001). Significant increases in acute cholecystitis (12.2% vs 17.3%
P <
.001), choledocholithiasis (12.8% vs 16.5%
P = .001), gallstone pancreatitis (10.6% vs 12.4%
P = .064), and chronic cholecystitis (1.4% vs 3.2%
P <
.001) also occurred. On interrupted time series analysis, change in month-to-month case count significantly increased during the pandemic (Figure 1
P <
.001), which persisted after exclusion of transferred patients. CONCLUSIONS: Pediatric cholecystectomy case volume and complexity increased during the COVID-19 pandemic. These findings may be secondary to changes in childhood health, transfer patterns, and shifts in access, highlighting an increased health care burden on children's hospitals.