Changes in appendicitis treatment during the COVID-19 pandemic – A systematic review and meta-analysis

Abstract

Background During the COVID-19 pandemic in 2020 a decrease of emergency consultations and modification in treatment of numerous medical conditions were observed. Aim of this paper was to evaluate the effect of the COVID-19 pandemic on incidence, treatment strategies, severity, length of hospital stay and time of presentation in adults and children with acute appendicitis. Methods A systematic literature search of Pubmed, Embase and Cochrane databases was performed, and eligible studies used to perform a meta-analysis. Results 46 suitable studies were identified with an overall reduction of appendicitis cases by 20.9% in adults and an increase of 13.4% in children. The rate of open appendectomies increased without statistical significance in both groups (adults: 8.5% vs. 7.1%, P = 0.32; children: 7.1% vs. 5.3%, P = 0.13), whereas the rate of antibiotic treatment increased significantly (P = 0.007; P = 0.03). Higher rates of complicated appendicitis were observed in adults (adults: OR 2.00, P < 0.0001; children: OR 1.64, P = 0.12). Time to first consultation did not change significantly (adults: 52.3 vs. 38.5 h – P = 0.057; children: 51.5 vs. 32.0 h – P = 0.062) and length of stay was also not lengthened during the pandemic (adults: 2.9 vs. 2.7 days, P = 0.057; children: 4.2 vs. 3.7 days, P = 0.062). Conclusion The COVID-19 pandemic of 2020 had major impact on incidence and treatment strategies of acute appendicitis. Results of this meta-analysis might be another hint to support the theory that appendicitis is not a progressive disease and surgeons can safely consider antibiotic therapy for acute uncomplicated appendicitis.

Incidence of Complicated Appendicitis during the COVID-19 Pandemic versus the Pre-Pandemic Period: A Systematic Review and Meta-Analysis of 2782 Pediatric Appendectomies

“…As per the findings from recent adult/pediatric studies, the patients developing appendicitis during the pandemic reach healthcare facilities on time (similar to the pre-pandemic period). Although an identical management algorithm of acute appendicitis was followed during the two time periods, more reliance on non-operative management was observed among the surgeons during the COVID-19 pandemic [ 69 , 70 ]. Our analysis shows the same result.…”

Changes in hospital admissions and complications of acute appendicitis during the COVID-19 pandemic: A systematic review and meta-analysis

“…Changes in AA treatment during the COVID-19 pandemic has been recently explored in two systematic reviews. [7] , [21] The number of studies identified by Köhler at al. [21] was lower compared to our work (46 vs. 54), in line with a literature search ended one month before (Feb 1 st vs. Mar 5 th 2021).…”

“… [7] , [21] The number of studies identified by Köhler at al. [21] was lower compared to our work (46 vs. 54), in line with a literature search ended one month before (Feb 1 st vs. Mar 5 th 2021). Similar to our findings, they demonstrated an overall significant reduction of AA cases by 21% in adults and an increase of 13% in children.…”

Multicenter cohort study on the presentation and treatment of acute appendicitis during the COVID-19 pandemic

“…Considering that acute abdominal pain, including appendicitis, is a condition that requires emergency (surgical) care, one would not expect a decrease in hospital admissions during the COVID-19 pandemic, yet multiple studies have demonstrated a significant decrease in referrals for acute appendicitis [ 5 – 9 ]. In addition, several studies have reported an increase in the proportion of complex acute appendicitis [ 6 , 8 – 16 ], as well as a prolonged time between onset of symptoms and hospital admission [ 8 , 10 – 12 , 14 ].…”