Evolving Trends in the Management of Acute Appendicitis During COVID‐19 Waves: The ACIE Appy II Study

Abstract

Background In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide.

Outpatient Non‐operative Management of Uncomplicated Acute Appendicitis: A Non‐inferiority Study

“…The majority of surgeons still consider NOM an ineffective treatment for uncomplicated appendicitis, even in the four participating hospitals. This is well reflected by two recent large international surveys reporting that NOM is the preferred treatment for only 14% of respondents [ 17 , 18 ]. When compared to patients receiving NOM, patients who underwent upfront appendectomy had higher WBC count and AIR score, more frequent detection of appendicolith and free fluid at ultrasound/CT scan.…”

Editorial: Gastrointestinal Surgery: Emerging techniques, controversies and state of art

“…The deferral of elective procedure during COVID-19 pandemics has created a backlog of millions of surgical procedures, an unexpected challenge for healthcare system worldwide ( 9 ). Even in urgent surgery, a shift toward nonoperative management has occurred as revealed by Stavridis et al in their systematic review on acute cholecystitis management, a similar trend observed in the management of acute appendicitis ( 10 ).…”

Authors’ Reply: Evolving Trends in the Management of Acute Appendicitis During COVID‐19 Waves: The ACIE Appy II Study

“…We thank Yang and colleagues for their correspondence highlighting the results of ACIE Appy II study [ 1 ] and proposing the endoscopic retrograde appendicitis therapy (ERAT) as a new tool to improve the management of acute appendicitis (AA) even during pandemic times.…”

“…We did not include any questions about ERAT in the ACIE Appy studies [ 1 , 2 ] because no guideline or scientific society recommended it for AA at the time of the study [ 3 , 4 ].…”