Acute Appendicitis During Coronavirus Disease 2019 (COVID-19): Increasing Incidence of Complicate Appendicitis, Severity and Length of Hospitalization

Background Reports of an increased proportion of complicated appendicitis during the Covid-19 pandemic suggest a worse outcome due to delay secondary to the restrained access to health care, but may be explained by a concomitant decrease in uncomplicated appendicitis. We analyze the impact of the pandemic on the incidences of complicated and uncomplicated appendicitis. Method We did a systematic literature search in the PubMed, Embase and Web Of Science databases on December 21, 2022 with the search terms (appendicitis OR appendectomy) AND (“COVID” OR SARS-Cov2 OR “coronavirus”). Studies reporting the number of complicated and uncomplicated appendicitis during identical calendar periods in 2020 and the pre-pandemic year(s) were included. Reports with indications suggesting a change in how the patients were diagnosed and managed between the two periods were excluded. No protocol was prepared in advance. We did random effects meta-analysis of the change in proportion of complicated appendicitis, expressed as the risk ratio (RR), and of the change in number of patients with complicated and uncomplicated appendicitis during the pandemic compared with pre-pandemic periods, expressed as the incidence ratio (IR). We did separate analyses for studies based on single- and multi-center and regional data, age-categories and prehospital delay. Results The meta-analysis of 100,059 patients in 63 reports from 25 countries shows an increase in the proportion of complicated appendicitis during the pandemic period (RR 1.39, 95% confidence interval (95% CI 1.25, 1.53). This was mainly explained by a decreased incidence of uncomplicated appendicitis (incidence ratio (IR) 0.66, 95% CI 0.59, 0.73). No increase in complicated appendicitis was seen in multi-center and regional reports combined (IR 0.98, 95% CI 0.90, 1.07). Conclusion The increased proportion of complicated appendicitis during Covid-19 is explained by a decrease in the incidence of uncomplicated appendicitis, whereas the incidence of complicated appendicitis remained stable. This result is more evident in the multi-center and regional based reports. This suggests an increase in spontaneously resolving appendicitis due to the restrained access to health care. This has important principal implications for the management of patients with suspected appendicitis.

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Spontaneous Resolution of Uncomplicated Appendicitis may Explain Increase in Proportion of Complicated Appendicitis During Covid‐19 Pandemic: a Systematic Review and Meta‐analysis

Andersson

Agiorgiti

Bendtsen

2023

World j. surg.

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Phlegmonous appendicitis in children with coronavirus infection COVID-19

Feklisova,

Olkhova,

Rastrigina

et al. 2023

Medicinskij alfavit

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The increase in cases of appendicitis observed during the COVID-19 pandemic requires an analysis of the causes of this situation and the determination of tactics for the diagnostic and surgical treatment of these patients. In 2020–2022 at the St. Vladimir Children’s Clinical Hospital, among hospitalized and operated patients for appendicitis, 16 patients were identiﬁed who simultaneously had a positive result of testing a swab from the nasopharynx for the presence of SARS-CoV-2 RNA. All patients are schoolchildren with a predominance of high school students. The disease began acutely with the appearance of abdominal pain, accompanied by repeated vomiting. There was no high fever, in half of the cases the temperature was subfebrile (37.2–37.8 °C), in other cases it remained normal. The respiratory syndrome preceded the abdominal one in three patients, and six more patients had hyperemia of the palatine arches and posterior pharyngeal wall. Respiratory failure, hypoxia were absent. Chest CT showed no changes. In all cases, abdominal ultrasound revealed ECHO signs of inﬂammatory transformation of appendix fragments. Operations were performed laparoscopically. The results of the morphological study of the removed appendix corresponded to the diagnosis of phlegmonous appendicitis, periappendicitis, mesenteriolitis. The postoperative course was uncomplicated, the pain syndrome was stopped, there was an improvement in clinical and laboratory parameters. Conclusion: phlegmonous appendicitis was observed in patients with coronavirus infection; surgical treatment led to the recovery of patients.

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Acute Appendicitis During Coronavirus Disease 2019 (COVID-19): Increasing Incidence of Complicate Appendicitis, Severity and Length of Hospitalization

Cited by 2 publications

References 51 publications

Spontaneous Resolution of Uncomplicated Appendicitis may Explain Increase in Proportion of Complicated Appendicitis During Covid‐19 Pandemic: a Systematic Review and Meta‐analysis

Spontaneous Resolution of Uncomplicated Appendicitis may Explain Increase in Proportion of Complicated Appendicitis During Covid‐19 Pandemic: a Systematic Review and Meta‐analysis

Phlegmonous appendicitis in children with coronavirus infection COVID-19

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