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

Grossi, Ugo; Gallo, Gaetano; Ortenzi, Monica; Piccino, Marco; Salimian, Nick; Guerrieri, Mario; Sammarco, Giuseppe; Felice, Carla; Santoro, G. A.; Saverio, Salomone Di; Tanna, Gian Luca Di; Zanus, Giacomo

doi:10.1016/j.hsr.2022.100021

Cited by 8 publications

(10 citation statements)

References 71 publications

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“…Alberto Sartori et al observed an increase in the number of post-operative complications in 2020 compared to 2019 ( 22 ). A META analysis that included 54 studies found the pandemic has altered the rate of admissions for AA and appendectomy, with parallel increased incidence of complicated cases in all age groups ( 23 ). The differences between these studies and our results may stem from the stringency of lockdown measures and the cost of surgery in different countries.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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“…In addition, other significant differences were reported between the COVID-19 group and the control group: duration of symptoms greater than 48 h (61 vs. 26%, P <0.001), longer intervention time (77 vs. 61 min, P =0.002), length of stay longer than two days (63 vs. 32%, P <0.001), and duration of ATB treatment longer than three days (36 vs. 24%, P =0.001) 3 . The systematic review of 54 articles by Grossi et al has similar results: the incidence of complicated appendicitis was increased in all age groups having received this diagnosis during the pandemic 11 . The same conclusions were also drawn in the study by Orthopoulos et al .…”

Section: Introductionmentioning

confidence: 75%

Patients with appendicitis during COVID-19 pandemic: a retrospective cohort study

Ricard

Marceau

Larouche

et al. 2023

Annals of Medicine &Amp; Surgery

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Background: The Coronavirus Disease 19 (COVID-19) pandemic greatly affected the Quebec healthcare system from spring 2020 onward; the consultation delays that were generated may have delayed the management of urgent intra-abdominal pathologies. Our objective was to evaluate the impact of the pandemic on the length of stay and complications within 30 days of treatment of patients consulting for acute appendicitis (AA) at the Centres intégrés universitaires de santé et de services sociaux (CIUSSS) de l’Estrie-Centre hospitalier universitaire de Sherbrooke (Estrie-CHUS), Quebec, Canada. Methods: The authors conducted a single-center retrospective cohort study on the charts of all patients diagnosed with AA at the CIUSSS de l’Estrie-CHUS between March 13 and June 22, 2019 (control group) and between March 13 and June 22, 2020 (pandemic group). This corresponds to the first wave of COVID-19 in Quebec. Patients included were those with a radiologically confirmed diagnosis of AA. There was no exclusion criteria. Outcomes assessed were length of hospital stay and 30-day complications. Results: The authors analyzed the charts of 209 patients with AA (117 patients in the control group and 92 patients in the pandemic group). No statistically significant difference was observed for the length of stay or the complications between the groups. The only significant difference was the presence of hemodynamic instability on admission (22.2 vs. 41.3%, P=0.004) as well as a trend that did not reach statistical significance regarding the proportions of reoperation before 30 days (0.9 vs. 5.4%, P=0.060). Conclusion: In conclusion, the pandemic did not affect the length of stay of AA managed at the CIUSSS de l’Estrie-CHUS. It is not possible to conclude whether the first wave of the pandemic influenced complications related to AA.

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“…As the proportion of complicated appendicitis is determined by the number of complicated appendicitis as numerator and the total number of patients with appendicitis as denominator, the concomitant decrease in the number of patients with uncomplicated appendicitis must also have had an impact [ 4 ]. It is known that variations in the incidence rate of uncomplicated appendicitis are more closely associated with the proportion of complicated appendicitis [ 8 ], whereas the impact of the Covid pandemic on the proportion of complicated appendicitis has been analyzed in several meta-analyses we have not seen any previous analysis of the impact on the incidences of complicated and uncomplicated appendicitis separately [ 2 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…A large number of studies and meta-analyses have reported an increase in the proportion of complicated appendicitis during the Covid-19 pandemic, suggesting increased delay as explanation [1][2][3][4][5][6][7]. Some studies also report a concomitant decrease in the number of uncomplicated appendicitis, suggesting that undiagnosed uncomplicated appendicitis may resolve without treatment due to the restrained access to health care [4].…”

Section: Introductionmentioning

confidence: 99%

Spontaneous Resolution of Uncomplicated Appendicitis may Explain Increase in Proportion of Complicated Appendicitis During Covid‐19 Pandemic: a Systematic Review and Meta‐analysis

2023

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Background Reports of an increased proportion of complicated appendicitis during the Covid-19 pandemic suggest a worse outcome due to delay secondary to the restrained access to health care, but may be explained by a concomitant decrease in uncomplicated appendicitis. We analyze the impact of the pandemic on the incidences of complicated and uncomplicated appendicitis. Method We did a systematic literature search in the PubMed, Embase and Web Of Science databases on December 21, 2022 with the search terms (appendicitis OR appendectomy) AND (“COVID” OR SARS-Cov2 OR “coronavirus”). Studies reporting the number of complicated and uncomplicated appendicitis during identical calendar periods in 2020 and the pre-pandemic year(s) were included. Reports with indications suggesting a change in how the patients were diagnosed and managed between the two periods were excluded. No protocol was prepared in advance. We did random effects meta-analysis of the change in proportion of complicated appendicitis, expressed as the risk ratio (RR), and of the change in number of patients with complicated and uncomplicated appendicitis during the pandemic compared with pre-pandemic periods, expressed as the incidence ratio (IR). We did separate analyses for studies based on single- and multi-center and regional data, age-categories and prehospital delay. Results The meta-analysis of 100,059 patients in 63 reports from 25 countries shows an increase in the proportion of complicated appendicitis during the pandemic period (RR 1.39, 95% confidence interval (95% CI 1.25, 1.53). This was mainly explained by a decreased incidence of uncomplicated appendicitis (incidence ratio (IR) 0.66, 95% CI 0.59, 0.73). No increase in complicated appendicitis was seen in multi-center and regional reports combined (IR 0.98, 95% CI 0.90, 1.07). Conclusion The increased proportion of complicated appendicitis during Covid-19 is explained by a decrease in the incidence of uncomplicated appendicitis, whereas the incidence of complicated appendicitis remained stable. This result is more evident in the multi-center and regional based reports. This suggests an increase in spontaneously resolving appendicitis due to the restrained access to health care. This has important principal implications for the management of patients with suspected appendicitis.

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

Cited by 8 publications

References 71 publications

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

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

Patients with appendicitis during COVID-19 pandemic: a retrospective cohort study

Spontaneous Resolution of Uncomplicated Appendicitis may Explain Increase in Proportion of Complicated Appendicitis During Covid‐19 Pandemic: a Systematic Review and Meta‐analysis

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