Clinical Experience of Emergency Appendectomy under the COVID-19 Pandemic in a Single Institution in South Korea

Abstract

Background and Objectives: The COVID-19 pandemic has brought serious changes in healthcare systems worldwide, some of which have affected patients who need emergency surgery. Acute appendicitis is the most common surgical disease requiring emergency surgery. This study was performed to determine how the COVID-19 pandemic has changed the treatment of patients with acute appendicitis in South Korea. Materials and Methods: We retrospectively reviewed a medical database that included patients who underwent surgery for acute appendicitis in our hospital from January 2019 to May 2021. We classified the patients into two groups according to whether they were treated before or after the COVID pandemic and 10 March 2020 was used as the cutoff date, which is when the World Health Organization declared the COVID pandemic. Results: A total of 444 patients were included in the “Pre-COVID-19” group and 393 patients were included in the “COVID-19” group. In the “COVID-19” group, the proportion of patients with severe morbidity was significantly lower. The time that the patients spent in the emergency room before surgery was significantly longer in the ”COVID-19” group (519.11 ± 486.57 min vs. 705.27 ± 512.59 min; p-value < 0.001). There was no difference observed in the severity of appendicitis or in the extent of surgery between the two groups. Conclusions: During the COVID-19 pandemic, a statistically significant time delay (186.16 min) was needed to confirm COVID-19 infection status. However, there was no clinical difference in the severity of appendicitis or in the extent of surgery. To ensure the safety of patients and medical staff, a COVID-19 PCR test should be performed.

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.…”

“…We believe the significant increase in complicated appendicitis can account for the significant increase in rates of caecectomy and intraoperative insertion of drains. Other studies that recorded rates of caecectomy during the pandemic did not identify a significant increase [ 37 – 39 ]. Only one of these studies identified a significant increase in the rates of complicated appendicitis during the pandemic, and all were conducted in Korea and therefore examined a different population and health system.…”

Impact of the COVID-19 pandemic on the outcomes of laparoscopic appendectomy for acute appendicitis

“…In addition, our hospital was not a COVID-19-dedicated hospital, and the impact of COVID-19 on hospital capacity was minimal. However, 1 study found that the time spent in the emergency department before surgery was significantly longer in the pandemic group (519.11 ± 486.57 minutes vs. 705.27 ± 512.59 minutes, P < 0.001) [ 23 ]. In our study, the 30-day postoperative complication rates and severity were similar between the 2 groups.…”