Appendectomy During the COVID-19 Pandemic in Italy. A Multicenter Ambispective Cohort Study by the Italian Society of Endoscopic Surgery and new technologies (the CRAC study).

Abstract

Background To determine on a national basis the surgical activity regarding appendectomies during the first Italian wave of the COVID-19 pandemic. Major surgical societies advised using non-operative management of appendicitis and suggested against laparoscopy during the COVID-19 pandemic. Methods Multicenter, observational study investigating the outcomes of patients undergoing appendectomy in the two months of March-April 2019 vs. March-April 2020. The primary outcome was the number of appendectomies performed during each of the two months, classified according to the American Association for the Surgery of Trauma (AAST) score. Secondary outcomes were the type of surgical technique employed (laparoscopic vs. open), and the complication rates. Results 1541 patients with acute appendicitis underwent surgery during the two study periods. 1337 (86.8%) patients met the study inclusion criteria. 546 (40.8%) patients underwent surgery for acute appendicitis in 2020 and 791 (59.8%) in 2019. Patients with complicated appendicitis operated in 2019 were 76 (9.6%) vs. 87 (15.9%) in 2020 (p = 0.001). An increase in the number of post-operative complications was found in 2020 (15.9%) compared to 2019 (9.6%) (p < 0.001). The following determinants increased the likelihood of complication occurrence: undergoing surgery during 2020 (+ 67%), having a unit AAST (+ 26%) increase, having waited for surgery > 24 h (+ 58%), being the surgeon aged > 40 years (+ 47%), undergoing open surgery (+ 112%) and being converted to open surgery (+ 166%). Conclusions In Italian hospitals, in March and April 2020, the number of appendectomies has drastically dropped. Patients undergoing surgery during the first pandemic wave were more frequently affected by more severe appendicitis than the previous year's timeframe and a higher complication rate was reported. Trial registration: ResearchRegistry ID 5789.

Presentation and outcomes of acute appendicitis during COVID-19 pandemic: lessons learned from the Middle East—a multicentre prospective cohort study

“…The lower negative appendectomy rate in the COVID period may be attributed to strict selection criteria, entailing an increased use of CT scans that were applied before appendectomy during the COVID-19 period. This was to avoid non-indicated surgery and unnecessary use of operation rooms and resources at these difficult times [31,32,53,54,59].…”

The comparison of Post-Operative Complications pre Covid era versus during Covid-Era based on Clavien-Dindo-classification: A Systematic Review and Meta-Analysis

“…Changes in resources availability were also presented in most studies (REF?). Three out of the ten studies in our meta-analysis suggested significantly higher rate of postoperative complications (22) and one of the two reported more severe complications in the COVID -19 era compared to the control cohort (24). Both studies were conducted in the first COVID -19 wave in Italy which was one of the first countries to experience the SARS-COV-2 outbreak.…”

“…Massive employment of health care resources resulted in canceling and postponing surgeries. Some studies reported an increase in postoperative complications (24,55,56). As far as we aware this study is among first systematic reviews studying on complication of surgeries during the pandemic so far.…”

“…Delay in hospital referral due to public fear of COVID -19, has led to more critical condition of patients at the admission time which was accompanied by more complicated surgical state and higher mortality, especially for emergency surgeries. (24,27,61,62). On the other hand, health care providers preferred close observation and conservative management to surgery in patients with younger age and better overall health condition (31,63,64) So the majority of operations were performed on elder adults with multiple comorbidities and more critical conditions with poorer prognosis (24,33,34,46,52,65).…”

“…(24,27,61,62). On the other hand, health care providers preferred close observation and conservative management to surgery in patients with younger age and better overall health condition (31,63,64) So the majority of operations were performed on elder adults with multiple comorbidities and more critical conditions with poorer prognosis (24,33,34,46,52,65).…”