Management of acute appendicitis during the COVID-19 pandemic: Views of two Brazilian surgical societies

Abstract

Acute appendicitis (AA) is a frequent cause of abdominal pain requiring surgical treatment. During the COVID-19 pandemic, surgical societies considered other therapeutic options due to uncertainties in the evolution of the disease. The purpose of this study is to assess the treatment of AA by members of two Brazilian surgical societies in this period. A common questionnaire was sent in 2020. There were 382 responses. Most surgeons had more than 15 years of profession (68.3%) and treated more than five cases per month (44.8%). About 72.5% would indicate chest CT to investigate COVID-19 in patients with AA. For those patients sustaining uncomplicated AA, without COVID-19, 60.2% would indicate laparoscopic appendectomy (VLA), followed by open appendectomy (OA) (31.7%) and non-operative management (NOM) (1.3%). For those with mild COVID-19, OA was suggested by 51.0%, followed by VLA (29.6%) and NOM (6.0%). For those with severe COVID-19, OA was proposed by 35.3%, followed by NOM (19.9%) and VLA (18.6%). For patients with periappendiceal abscesses, without COVID-19, VLA was suggested by 54.2%, followed by OA (33.2%) and NOM (4.4%). For those with mild COVID-19, OA was proposed in 49.5%, followed by VLA (29.3%) and NOM (8.9%). In those with severe COVID-19, OA was proposed in 36.6%, followed by NOM (25.1%) and VLA (17.3%). This information, based on two recognized Brazilian surgical societies, can help the surgeon to select the best approach individually.

Impact of the COVID‐19 pandemic and the restrictions on pediatric appendicitis in Turkey: A single‐center experience

“…In the study, the rate of COVID‐19 positivity was 3.5% (10 of 285) in the whole group and 6.9% (10 of 143) during the pandemic period, which was higher than that reported in the literature where the prevalence of COVID‐19 in the AA population varies between 5.1% and 5.8%, and between 2% and 5% in children 35,42,43 . Similar to some studies, but different from most studies, there was no increase in the frequency of complications in COVID‐19‐positive cases 6,7,10,27,30,44,45 . Although there was no increase in the complication prevalence, the frequency and level of fever and the mean length of hospital stay of COVID‐19‐positive patients in the pandemic period were higher than in the pre‐pandemic period.…”

“…35,42,43 Similar to some studies, but different from most studies, there was no increase in the frequency of complications in COVID-19-positive cases. 6,7,10,27,30,44,45 Although there was no increase in the complication prevalence, the frequency and level of fever and the mean length of hospital stay of COVID-19-positive patients in the pandemic period were higher than in the pre-pandemic period. Fever-related findings may be related to COVID-19 independent of AA.…”

Incidence of Complicated Appendicitis during the COVID-19 Pandemic versus the Pre-Pandemic Period: A Systematic Review and Meta-Analysis of 2782 Pediatric Appendectomies

“…Management of pediatric appendicitis during this pandemic must be evaluated individually for every hospital and its capacity for SARS-CoV-2 testing, laboratory tests, imaging options, bed, staff, emergency ward capacity and personal protective equipment capacity. Although appendectomy should not be impacted by restrictions on elective procedures several institutions, countries and professional associations recommend performing NOM for appendicitis during pandemic [ 73 ].…”