Impact of Coronavirus disease 2019 (COVID‐19) on acute appendicitis in Hong Kong: Retrospective cohort study in a local cluster hospital

Abstract

Background Coronavirus disease 2019 (COVID‐19) impacted Hong Kong in early January 2020. Quarantine and social distancing measures have been implemented to prevent disease spread. Material and Method Retrospective cohort study was carried out in our cluster to compare the acute appendicitis cases during pandemic period, January 1, 2020 to June 30, 2020, with the same period 1 year before. Parameters including time of presentation, complicated appendicitis rate, operative time, post‐operative complication rate, and total length of stay were compared and analysed. Results A total number of 348 patients (160 in the pre‐COVID group versus 188 in the post‐COVID group) were included. There is no significant difference in basic demographics. The time of presentation was significantly longer in March (3.75 days vs 1.56 days, P = .031) and June 2020 (3.02 days vs 1.88 days, P = .026) compared with the pre‐COVID group, which correlate with the spike of local confirmed cases. There was a significantly higher incidence of complicated appendicitis (67% vs 52%, P = .028) and post‐operative complication rate (29% vs 7%, P = .042) in February post‐COVID group compare with the pre‐COVID group. Conclusion During the COVID‐19 pandemic period, more patients with acute appendicitis presented late to the hospital, with an increase in complicated appendicitis rate and post‐operative complication rate.

COVID-19 and Complicated Appendicitis: What is the Relationship?

“…The implication of delay in the operative treatment of appendicitis includes increased morbidity and post-operative complications [7] as reflected in this study, with increased operative time (P=.00), increased length of hospital stay (P=.00) and increased rate of postoperative complications (P=.00) in the group presenting with complicated appendicitis. This is similar to findings by other authors [22] and has undoubtedly increased the strain on health resources already stretched by this pandemic.…”

“…This might have required screening investigations which are often not readily available, [15] with the result being a delay in referral and/or operative intervention and increased potential for developing complications. Thirdly, although appendicectomy is the gold standard in the management of acute uncomplicated appendicitis, [7,16] several centres are increasingly adopting conservative management of uncomplicated and even complicated appendicitis during the pandemic [17][18][19]. This might have been a strategy to reduce potential contact of the surgical team and operating room environment with the SARS CoV-2 virus.…”

“…Since then, emergency surgical services have been disrupted worldwide due to reassignment of surgical staff to combat the pandemic and sometimes, closure of entire surgical units [4]. Acute appendicitis is the most common surgical emergency in Nigeria [5,6] and studies have suggested changing trends in the presentation of this disease occasioned by the current pandemic [7]. We have observed an unusual influx of cases of acute complicated appendicitis within a relatively short period of time in the general surgery unit of Benue State University Teaching Hospital (BSUTH), Makurdi, Nigeria compared to a similar period a year earlier.…”

Has the frequency of complicated appendicitis changed in children in the first year of the COVID-19 pandemic?

“…The COVID-19 pandemic process, which started in December 2019 and continues, caused disruption in the routine functioning of life. In order to control the spread of the disease, restrictions such as quarantine and curfew were applied, elective operations were postponed, and only emergency operations were performed [ 1 ]. During the pandemic period, the number of patients admitted to the hospital for reasons such as fear of contact with patients with COVID-19 and difficulty in transportation, especially in rural areas, decreased [ 2 , 3 ].…”

“…Appendicitis is the most common disease requiring emergency surgery in children. Prolongation of the time between the onset of symptoms and admission to the hospital for 48 h or more increases the risk of developing complications such as ischemia, gangrene, and perforation in the appendix [ 1 , 4 ]. The COVID-19 pandemic period suggests that the rate of complications may have increased in patients requiring surgical treatment due to the fact that they could not come to the hospital at the onset of the symptom.…”