Introduction Early during the COVID-19 pandemic, surgeons were advised to use conservative management/open surgery for appendicitis. This single-centre study has explored the resulted management differences. Method Retrospective study covering Prepandemic-data over March-May,2019 & Pandemic-data over March-May,2020. Results Prepandemic-(43 patients): Mean age was 38.3 years. Mean length-of-stay was 1.7 days. Preoperative imaging was used in 32(74.4%) patients; this was diagnostic in 28(87.5%). Non-surgical management was used in 4(9.3%) patients; one needed surgery eventually. Surgical approaches in 40 patients were (laparoscopic: 38(95%), open: 2(5%)). Neither significant morbidity nor mortality was reported. Pandemic-(35 patients): Mean age was 31.2 years. Mean length-of-stay was 2.2 days. Preoperative imaging was used in 30(85.7%) patients; this was diagnostic in 26(86.6%). Non-surgical management was used in 8(22.9%) patients; one needed surgery eventually. Surgical approaches in 28 patients were (laparoscopic: 10(35.7%), open: 18(64.3%)). Neither significant morbidity nor mortality was reported, apart from one patient with COVID-19 postoperative infection. Conclusions There was a tendency towards conservative approach/open surgery during the pandemic. Though this was statistically significant (p < 0.05), the total number of patients was small to achieve stronger conclusions. Laparoscopy was selectively used during the pandemic where the benefit outweighed the risks.
Introduction: Early during the COVID-19 pandemic, the royal college of surgeons advised to use Non-Operative Treatment of appendicitis NOTA or otherwise open surgery for appendicitis. This study has explored the resulted management differences, and the outcome after one year follow up. Methods: Retrospective study covering Pre-pandemic data over March-May,2019 & COVID-19 pandemic data over March-May,2020. We compared the outcome of non-operative treatment approach (NOTA), open and laparoscopic surgical outcome between the 2 groups. Results: The number of admissions was lower in the COVID compared to the Pre-COVID Group (35 vs 43). In the COVID group had more CT scanning of the abdomen and pelvis (65.7% vs 42.2%; p=0.036). There was no difference in the diagnostic value for these imaging methods between the 2 groups (87.5% vs 86.6%) During COVID period Signicantly fewer patients underwent surgery (77.1 vs 92.8; p<0.04), There were signicantly more complicated appendicitis cases in the COVID group compared to Pre-COVID group (59.2 vs 28.2; p:0.021). There was in reduction LOS when comparing Laparoscopic to NOTA (1.7 vs 2.6 days; p:0.03). There has been higher complication rate in the open and NOTA treatments compared to Laparoscopic, but this was not statistically signicant (24.3 % vs 14.8%; p: 0.29). In the NOTA group 41 % of the patients had emergency or interval appendectomy in after one year follow up period. Conclusions: There was a tendency towards conservative approach/open surgery during the pandemic. Our study suggests that Laparoscopic surgery should remain the preferred method of management of appendicitis during COVID-19 pandemic considering the more complicated appendicitis. NOTA should be limited to selected high risk patients. accepting the risk of disease recurrence and need for further interval or emergency surgery
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