An indirect effect of COVID-19 pandemic: Increased pediatric perforated appendicitis rate due to delayed admission

Abstract

Objective: Appendicitis is a common surgical emergency among children. The coronavirus pandemic affected the system of hospitals more than any other field, and great amount of people were concerned about visiting the hospitals for any reason. In this study, it was aimed to evaluate the profile of appendicitis by emphasizing perforated and acute appendicitis in the pandemic period and to compare the rates with previous three years. Material and Methods: Charts of the children who underwent laparoscopic appendectomy due to appendicitis between March 11-September 30 between 2017-2020 were retrospectively analyzed in terms of demographic data, duration of symptoms, duration between hospital admission and surgery, radiologic imaging and perioperative outcomes. Results: This study includes 467 children who underwent laparoscopic appendectomy. There were 97 procedures in 2020, 111 in 2019, 146 in 2018 and 113 in 2017. Multiple comparison tests revealed that age did not show difference; but onset of symptoms in admission (p= 0.004), hospitalization time before surgery (p< 0.001), total hospitalization time (< 0.001) showed statistically significant difference between years. Pairwise comparisons showed that these parameters were increased in 2020 compared to other years. Perforated appendicitis rate was significantly increased in 2020 when compared to previous years. Conclusion: Although there is no direct relation between appendicitis and COVID-19 infection in the current knowledge, perforated appendicitis was found to be increased in children during the COVID pandemic. Reason of the higher rate of perforated appendicitis may be multifactorial; however, the pandemic appears to have a role in increased morbidity in children with appendicitis indirectly due to delay of hospital admissions.

Reasons for Delayed Diagnosis of Pediatric Acute Appendicitis during the COVID-19 Era: A Narrative Review

“…Ergün et al showed prolonged times between the onset of symptoms and hospital admission, longer hospitalization times before surgery and longer LOSs. Perforation rates increased by 18-19% on average during the pandemic in comparison to the previous three years [41]. Analogous results were also reported by another three authors [49,104,105].…”

“…As the pandemic continued, all these factors improved; however, wide testing meant that most surgeons waited for SARS-CoV-2 PCR patient results before operating. The study by Ergün et al established with statistical significance that time from hospital admission to surgery or NOM was indeed greater during the pandemic but did not lead to increased perforation rates for children [41]. This has been the case for adults [9,92].…”