Impact of COVID-19 Outbreak on the Emergency Presentation of Acute Appendicitis

Abstract

Background The global crisis resulting from the coronavirus pandemic has imposed a large burden on health systems worldwide. Nonetheless, acute abdominal surgical emergencies are major causes for nontrauma-related hospital admissions and their incidences were expected to remain unchanged. Surprisingly, a significant decrease in volume and a higher proportion of complicated cases are being observed worldwide. Methods The present study assesses the local impact of the coronavirus pandemic on the emergency presentation of acute appendicitis in a Brazilian hospital. A retrospective analysis was conducted on patients undergoing emergency surgery for the clinically suspected diagnosis of acute appendicitis during the 2-month period of March and April 2020 and the same time interval in the previous year. Data on demographics, timing of symptom onset and hospital presentation, intraoperative details, postoperative complications, hospital length of stay, and histological examination of the specimen were retrieved from individual registries. Results The number of appendectomies during the pandemic was 36, which represents a 56% reduction compared to the 82 patients operated during the same period in 2019. The average time of symptom onset to hospital arrival was significantly higher in 2020 (40.6 vs. 28.2 hours, P = .02). The classification of appendicitis revealed a significant higher proportion of complicated cases than the previous year (33.3% vs. 15.2%, P = .04). The rate of postoperative complications and the average length of stay were not statistically different between the groups. Conclusion Further assessment of patients’ concerns and systematic monitoring of emergency presentations are expected to help us understand and adequately address this issue.

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.…”

The decrease of non-complicated acute appendicitis and the negative appendectomy rate during pandemic

“…During the pandemic period, it was observed that fewer people applied to the emergency services, causing the diseases that these people applied to progress more [ 4 ]. In many studies, it is stated that admissions have increased due to complicated appendicitis [ 4 , 5 ]. Finkelstein et al stated that during the COVID-19 quarantine, there were more patients presenting with perforated appendicitis compared to the same period of the previous year, possibly due to observance of quarantine restrictions and fear of contracting COVID-19 in the hospital [ 6 ].…”

The effect of the Covid-19 outbreak on the management of acute appendicitis: A retrospective comparative cohort study

“…Lower length of hospital stay is desired and favored during the pandemic to decrease the contamination of Cov19 and to empty the beds for a new outbreak. Some studies reported no differences in LOS between these periods [16][17]; however, Kvasnovsky et al [18] reported a significantly higher LOS for AA during the pandemic. Conservatively treated AA patients had longer LOS than the operated patients in both periods [14,19].…”

“…Gao et al [33] reported an increased rate of complicated appendicitis due to delayed admission or surgery and decreased P a g e | 911 intention to seek treatment at Cov19. Fonseca et al [17] reported the rate of complicated AA as 15.2% in the pre-pandemic period, and as 33.3% during the pandemic. In our study, the lower rate of complicated AA and luminal pathology implied the accurate indication and timing of appendectomy during the pandemic.…”