Comparison of acute appendicitis before and within lockdown period in COVID-19 era: A retrospective study from rural Nepal

Abstract

Introduction The world has been engulfed with the pandemic of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which have created significant impact in the emergency surgical health delivery including acute appendicitis. The main aim of this study was to compare the demographic and clinical parameters between two cohorts before the onset of lockdown and within the pandemic. Methods A retrospective analysis was performed between two groups A and B, who presented with acute appendicitis three months prior to and after initiation of lockdown on March 24 2020 respectively in one of the tertiary centers of Nepal. These two cohorts were compared in demographics, clinicopathological characteristics and surgical aspects of acute appendicitis. Results There were 42 patients in group A and 50 patients in group B. Mean age of the patients was 31.32±17.18 years with male preponderance in group B (N = 29). Mean duration of pain increased significantly in group B [57.8±25.9(B) vs 42.3±25.0(A) hours, P = 0.004] along with mean duration of surgery [51.06±9.4(B) vs 45.27±11.8(A) minutes, P = 0.015]. There was significant decrease in post-operative hospital stay among group B patients [3.04±1.1(B) vs 3.86±0.67(A) days, P = 0.0001]. Complicated cases increased in group B including appendicular perforation in 10 cases. Similarly, mean duration of presentation to hospital significantly increased in group B patients with perforation [69.6±21.01 vs 51.57±17.63 hours, P = 0.008]. Conclusion During the adversity of the current pandemic, increased number of cases of acute appendicitis can be dealt with surgery as the chances of late presentation and complexity of the lesion exists.

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

“…26 studies described a change in case number of appendicitis and/or appendectomies between comparable time periods before and during the COVID-19 pandemic in adults [ [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] ]. Studies were conducted in 15 countries (as shown in Fig.…”

“…Overall, 23 studies reported a reduction of appendicitis/appendectomy cases during the pandemic, compared to a similarly long time period in previous years. 3 studies described an increase of cases (mean increase: 80,0%) [ 16 , 25 , 36 ]. These three studies were performed in Austria, Nepal and Turkey.…”

“…10 studies compared the rate of open and laparoscopic appendectomies (OA and LA) before and during the COVID-19 pandemic in adults [ 11 , 16 , 23 , 30 , 35 , 40 , [53] , [54] , [55] , [56] ]. Overall, 15,589 appendectomies were performed.…”

“…11 studies examined the amount of conservatively treated patients with suspected AA before and during the COVID-19 pandemic [ 11 , 16 , 18 , 23 , 31 , 35 , 37 , 41 , [53] , [54] , [55] ]. Overall data of 18,084 patients were analysed, 4242 during and 13,842 before the onset of COVID-19.…”

“…Overall 25.581 patients were analysed: 18,107 before the onset of the pandemic and 7474 during the pandemic [ 16 , 18 , 20 , [23] , [24] , [25] , [26] , [27] , 30 , 31 , [34] , [35] , [36] , 41 , [54] , [55] , [56] , [57] , [58] , [59] ]. During the pandemic 26.6% of patients had complicated appendicitis, compared to 22.2% before the onset of the pandemic.…”