Antibiotics alone as an alternative to appendectomy for uncomplicated acute appendicitis in adults: Changes in treatment modalities related to the COVID-19 health crisis

Collard, M.; Lakkis, Zaher; Loriau, J.; Mège, Diane; Sabbagh, Charles; Lefèvre, Jérémie H.; Maggiori, Léon

doi:10.1016/j.jviscsurg.2020.04.014

Cited by 95 publications

(102 citation statements)

References 48 publications

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“…It is not possible to reduce emergency surgery without altering the quality of care provided to surgical patients [29]. The COVID-19 pandemic has impacted our practice [3] in favour of more conservative attitudes [2]. This was shown in this study as well.…”

Section: Changes In Clinical Practicesupporting

confidence: 53%

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How COVID changed surgical acute inflammatory diseases and surgeons clinical practice during the first wave of COVID-19

Guadalajara

Nova

Gonzalez

et al. 2020

Preprint

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BackgroundAnecdotal evidence suggests that community infection control measures during the COVID-19 outbreak have modified the number and natural history of acute surgical inflammatory processes (ASIP - appendicitis, cholecystitis, diverticulitis and perianal abscesses) admissions. This study aims to evaluate the impact of the COVID-19 pandemic on the presentation and treatment ASIP and quantify the effect of COVID-19 infection on the outcomes of ASIP patients. MethodsThis was a multicentre, comparative study, whereby ASIP cases from March 14th to May 2nd 2019 acted as historical controls for the cohort of patients with the same pathology during the COVID-19 pandemic. Data regarding patient and disease characteristics as well as outcomes, were collected from sixteen centres in Madrid, and one in Seville (Spain).ResultsThe number of patients treated for ASIP in 2019 was 822 compared to 521 in 2020. This reduction occurs mainly in patients with mild cases, while the number of severe cases was similar. ConclusionsThe number of ASIP cases treated during the pandemic was reduced by more than one third mainly due to a dramatic reduction in mild cases. This also has represented a selection of severe cases. We also found a more conservative approach to the patients this year, non-justified by clinical circumstances.The positive COVID-19 status itself did not have a direct impact on either morbidity or mortality. This is an interesting finding which if confirmed through future research with a larger sample size of COVID-19 positive patients, can expedite the recovery phase of acute surgical services.

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Section: Changes In Clinical Practicesupporting

confidence: 53%

“…The pandemic had an inevitable impact on the care provided to acute surgical patients. Guided by early reports of worryingly high adverse events rates after surgery conservative approaches have been favoured [2,3]. Attendances at the emergency departments due to surgical pathologies were reduced signi cantly [4,5].…”

Section: Introductionmentioning

confidence: 99%

How COVID changed surgical acute inflammatory diseases and surgeons clinical practice during the first wave of COVID-19

Guadalajara

Nova

Gonzalez

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…The COVID-19 pandemic has placed unprecedented stress on the healthcare system [ 1 ]. In response to government mandates and society recommendations, even emergency surgical procedures such as appendectomies have been curtailed, with non-surgical management used whenever possible [ 2 , 3 ]. The goal of our study was to determine whether changes in acute appendicitis management have altered the frequency of complications in these patients.…”

Section: Introductionmentioning

confidence: 99%

Non-operative Management for Acute Appendicitis During the COVID-19 Pandemic Does Not Increase the Rate of Complications

Patel

et al. 2021

Journal of Gastrointestinal Surgery

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“…Literature has reports wherein, appendicitis patient, even without a lump formation have been successfully managed on antibiotics with vigilant monitoring during this pandemic. [7,8]In available literature, the most common cause of mortality in COVID positive operated patients was Acute Respiratory Distress Syndrome with total mortality rate much higher than expected even for elective surgery. [9,10] Case1 wherein three of our doctors got infected with COVID further highlights the importance of an institutional protocol to deal with surgical patients in this pandemic time to prevent its transmission to health care workers.…”

Section: Discussionmentioning

confidence: 99%

COVID patients encountered by a general surgeon- 6 unique scenarios.

Jain¹,

Mehta²,

Aggarwal³

et al. 2020

Preprint

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Background and Objectives :With rising demand of surgical interventions post lockdown due to Corona Virus Infectious Disease(COVID)-19, surgeons need to restart their surgical practice shortly. To increase caution and safety, six scenarios in which a surgeon may encounter COVID patients are hereby highlighted in the present study.Patients and Methods:A hospital based case series analysis of eight surgical patients admitted in past two months was done. Clinical and radiological records of these patients were studied separately and concluded consensually by two surgeons.Results:Six unique scenarios were identified:1. COVID positive patient, with concurrent surgical pathology.2. COVID positive patient incidentally diagnosed with additional surgical pathology.3. A solely surgical patient mimicking COVID positive symptomatology.4. A COVID negative surgical patient acquiring nosocomial COVID infection postoperatively.5. COVID positive surgical patient with false negative COVID report.6. COVID suspected by intraoperative COVID specific intestinal findings and then getting postoperative COVID test positive for the patient.Interpretations:· Deferrable surgeries to be avoided· A stringent institutional protocol for all patients is the essence of current surgical practice.· Minimal surgical or radiological intervention should be sought whenever possible.· The bias towards COVID, should not let us miss a surgical pathology in patients mimicking COVID clinically.· The possibility of a false negative COVID test, should be kept in mind in patients with typical COVID like symptomatology.· Immunocompromised surgical patients susceptible to nosocomial COVID infections should be dealed with extra caution and precaution.

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Antibiotics alone as an alternative to appendectomy for uncomplicated acute appendicitis in adults: Changes in treatment modalities related to the COVID-19 health crisis

Cited by 95 publications

References 48 publications

How COVID changed surgical acute inflammatory diseases and surgeons clinical practice during the first wave of COVID-19

How COVID changed surgical acute inflammatory diseases and surgeons clinical practice during the first wave of COVID-19

Non-operative Management for Acute Appendicitis During the COVID-19 Pandemic Does Not Increase the Rate of Complications

COVID patients encountered by a general surgeon- 6 unique scenarios.

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