Effect of the Covid-19 Pandemic on the Clinical Evolution of Acute Appendicitis and Acute Cholecystitis

Abstract

Background: The World Health Organization declared a worldwide Coronavirus (COVID-19) pandemic on March 11, 2020. In Uruguay, unlike most countries, a mandatory confinement was not declared. On the contrary, an extensive education and prevention campaign was carried out associated with measures to reduce social mobility, such as prohibiting meetings and closing bars.Objectives: The aim of the present study was to evaluate the COVID-19 pandemic in Uruguay and its repercussion on the clinical evolution of the two most common surgical pathologies: acute appendicitis (AA) and acute cholecystitis (AC).Methods: A retrospective comparative cohort study was performed at the Emergency Department of the University Hospital “Hospital de Clinicas Manuel Quintela,” the most important tertiary referral hospital in the city of Montevideo, capital of Uruguay. Two cohorts were identified: 13th of March 2019 to 13th of June 2019 [Pre-Covid period (PCP)] and the same period in 2020 [Pandemic Covid period (PCVP)]. Demographic and clinical data were analyzed.Results: A total of 118 cases were registered in 2019 and 109 in 2020. There were 43 cases (36.4%) of acute appendicitis in the pre-Covid period and 42 cases (36.5%) in Pandemic Covid period (p = 0.745). Acute cholecystitis cases differed significantly between cohorts, with a raise of cases in the Pandemic Covid period (14 vs 25) (p = 0.027). The surgical approach (Laparoscopy vs Open) did not change significantly (p = 0.207). A significant increase in complicated cases (AA + AC) was found during the pandemic (PCP 57 cases vs PCVP 67 cases) (p < 0.001). The sub-analysis of AA and AC showed a significant increase in AA’s complicated cases during PCVP (14 vs 25; p < 0.001) and no significant changes in the AC group (p = 0.99).Conclusion: An increase of complicated cases of AA was observed with maintenance of the number of consultations that might be explained by the excellent pre-hospital care system and absence of lock-down measures. The results are contradictory in some aspects, which calls for a deeper analysis, comparing different realities and longer periods of time in order to be able to draw conclusions that are representative for the Coronavirus pandemic in Uruguay.