Emergency appendicectomy during COVID-19 pandemic – A single UK centre experience

Abstract

Background - In December 2019 following an outbreak of Novel coronavirus infection (COVID-19) in Wuhan, China, it spread rapidly overwhelming the healthcare systems globally. With little knowledge of COVID-19 virus, very few published reports on surgical outcomes; hospitals stopped elective surgery, whilst emergency surgery was offered only after exhausting all conservative treatment modalities. This study presents our experience of outcomes of emergency appendectomies performed during the pandemic. Methods – Prospectively we collected data on 132 patients in peak pandemic period from 1st March to 5th June 2020 and data compared with 206 patients operated in similar period in 2019. Patient demographics, presenting symptoms, pre-operative events, investigations, surgical management, postoperative outcomes and complications were analysed. Results – Demographics and ASA grades of both cohorts were comparable. In study cohort 84.4% and 96.7% in control cohort had laparoscopic appendicectomy. Whilst the study cohort had 13.6% primary open operations, control cohort had 5.3%. Mean length of stay and early post-operative complications (<30 days) were similar in both cohorts apart from surgical site infections (p = 0.02) and one mortality in study cohort. Conclusion – In these overwhelming pandemic times, although conservative treatment of acute appendicitis is an option, a proportion of patients will need surgery. Our study shows that with careful planning and strict theatre protocols, emergency appendicectomy can be safely offered with minimal risk of spreading COVID-19 infection. These observations warrant further prospective randomised studies. Keywords - appendicectomy, COVID-19, Coronavirus, emergency surgery, laparoscopy

Operative Management of Acute Appendicitis Was Safe During the COVID-19 Pandemic Shutdown

“…Our data also does not capture attrition rates and patients lost to follow up, which may result in underreported postoperative outcomes. Although there are some studies that have shown that appendectomies were safe during the pandemic 9 , further investigation is needed to better evaluate the safety and efficacy of operative management for appendicitis during the peak of the virus. With the advent of the COVID-19 vaccines, future steps would be to investigate long term trends in the natural history of appendicitis, treatment patterns, and post-treatment course in relation to COVID-19.…”

“…The management for acute appendicitis varied worldwide as the virus continued to spread and little was known. Given the expeditious rate of global infection spread, some countries and cities elected to proceed with nonoperative management while others elected to favor operative management when possible 8 , 9 , 10 , 11 , 12 , 13 . Given unknowns about the virus and how it affected patients with comorbidities, there was concern that operating on these patients would increase morbidity related to COVID as well as potential viral transmission from producing pneumoperitoneum.…”

Effect of the COVID-19 pandemic on patients with presumed diagnosis of acute appendicitis

“…The hospital admission rates have dropped during the quarantine. We evaluated 25 studies related with COVID-19 and AAp, and 23 of these articles reported that there was a 24% (IQR: 15%-39%; min-max: 5.4%-81%) drop in the hospital admissions due to AAp during the quarantine regulations[ 1 - 4 , 10 , 12 , 14 - 22 , 33 - 39 ]. In only 1 of the 25 studies, there was a 7% increase in the hospital admissions[ 40 ].…”

“…Ten of the 25 studies that were reviewed gave their results regarding negative appendectomy rates. The results of these studies showed that negative appendectomy rates dropped during the COVID-19 pandemic[ 1 , 6 , 13 - 16 , 18 , 33 , 34 , 39 ]. Five of the ten studies stated that this drop showed statistical significance.…”

“…Fourteen articles in our literature presented data regarding the duration of hospital stay in AAp during the pandemic. Ten of these studies showed no difference in duration between the different time intervals[ 4 , 13 , 19 - 22 , 35 , 36 , 39 , 40 ], while one study reported a prolonged hospital stay[ 1 ] and another study reported that the duration was shorter during the pandemic[ 14 ]. In addition, three studies reported that although there was no statistical difference, the duration of hospitalization during the pandemic tended to be longer[ 3 , 10 , 18 ].…”