Analysis of appendicitis management during COVID-19 pandemic: A study of Chinese adult cohorts

Abstract

BackgroundHealthcare seeking behavior has been widely impacted due to the restricted movements of individuals during the Coronavirus disease-19 (COVID-19) pandemic. This study aims to perform risk stratification in patients requiring timely intervention during the recovery periods.MethodsOperation notes of acute appendicitis (AA) patients within a hospital were analyzed during three six-month periods (23 January-23 July in 2019, 2020, and 2021, respectively). Patient data were collected retrospectively including demographics, pre-emergency status, perioperative information, postoperative outcomes, and follow-up results.Results321 patients were included in this study, with 111, 86, and 124 patients in 2019, 2020, and 2021 groups, respectively. The median age of patients decreased by 4 years in 2020 as compared to that in 2019. The proportion of pre-hospitalization symptoms duration of more than 48 h in the 2020 group was higher (36.05% in 2020 vs. 22.52% in 2019). Length of hospital stay (LOS) in 2020 was shorter than it was during the same period in 2019 (4.77 vs. 5.64) and LOS in 2021 was shorter than in 2019 (4.13 vs. 5.64). Compared to the lockdown period, the proportion of patients with recurrent AA was higher in the post-lockdown period (15.1% vs. 27.4%). The median age was 34 years (vaccinated) vs. 37 years (unvaccinated). Logistic regression suggests that elevated C-reactive protein (CRP) (OR = 1.018, CI = 1.010–1.028), white cell count (WBC) (OR = 1.207, CI = 1.079–1.350), female (OR = 2.958, CI = 1.286–6.802), recurrent (OR = 3.865, CI = 1.149–12.997), and fecalith (OR = 2.308, CI = 1.007–5.289) were associated with complicated appendicitis (CA).ConclusionThe lockdown measures during the COVID-19 epidemic are shown to be correlated with a reduction in the proportion of AA patients who underwent surgery, particularly in older adults. Risk factors for CA include elevated CRP, WBC, female, recurrent, and fecalith.

Navigating appendicitis care during the Covid-19 pandemic: a retrospective cohort study in China

“…The introduction of mandatory PCR testing for medical treatment seekers, except in emergency cases, has notably influenced the management of appendicitis, a common cause of abdominal pain and a leading indicator for emergency abdominal surgery worldwide [ 16 ]. While studies in some regions reported increased time from symptom onset to hospital visit and more complex cases due to these measures [ 7 , 17 ], our study, in alignment with other Chinese retrospective cohorts, found no significant differences in the management of appendicitis in China [ 10 ]. These findings suggest minimal influence on appendicitis patients’ seeking behaviors in China, potentially attributed to cultural nuances.…”

“…A critical finding of our study is the prolonged interval from emergency room admission to surgery during the pandemic, primarily due to the implementation of additional procedures such as real-time PCR testing [ 18 ], which takes approximately 4–6 h [ 10 ]. Although delayed surgical intervention can potentially exacerbate inflammation and complications, our study observed no direct impact on complication rates.…”

“…Initial reports from the height of the pandemic indicated a decrease in appendicitis cases, possibly due to reduced movement, limited social interactions, and fears of hospital exposure. Additionally, some studies observed a noted shift in the clinical presentation of appendicitis, with more advanced and complicated cases at hospital admission [ 7 – 9 ], while other studies indicated that delay in medical consultation did not necessarily translate into worse outcomes [ 10 , 11 ]. As we move beyond the pandemic, understanding the impact of lockdown measures on appendicitis is crucial for healthcare planning and preparedness.…”

Management of acute appendicitis during the COVID-19 pandemic: a retrospective cohort study

“…Patients undergoing operative management for appendicitis during the pandemic were assessed to have poorer overall health, as determined by their significantly higher ASA scores. This was not identified in other studies, which all reported no significant difference between the pandemic and control cohort ASA scores [ 37 , 38 , 42 ]. There are a number of explanations why our findings differed from other studies; the studies were conducted in different countries with differing health care systems, and the ASA is a subjective measure.…”