Organizational aspects of pediatric anesthesia and surgery between two waves of Covid-19.

Background The initial wave of the Covid-19 pandemic has hit Italy, and Lombardy in particular, with violence, forcing to reshape all hospitals' activities; this happened even in pediatric hospitals although the young population seemed initially spared from the disease. "Vittore Buzzi" Children's Hospital, which is a pediatric/maternal hospital located in Milan (Lombardy Region) had to stop elective procedures - with the exception of urgent/emergent ones - between February and May 2020 to leave space and resources to adults' care. We describe the challenges of re- shaping the hospital's identity and structure, re-starting pediatric surgery and anesthesia, from May on, in a mostly hit area of the world, with the purpose to avoid and contain infections. Both patient and caregiver admitted to hospital have been tested for Sars-CoV-2 in every case. Methods observational cohort study via review of clinical charts of patients undergoing surgery between 16th May and 30th September 2020, together with SARS-CoV -2 RT -PCR testing outcomes, and comparison to same period surgeries in 2019. Results An increase of approximately 70% in pediatric surgeries (OR 1.68 [1.33-2.13], p Conclusion we describe our pathway for safe pediatric surgery and anesthesia and the importance of testing both patient and caregiver.