Impact of <scp>COVID</scp>‐19 on appendicitis presentations in children in Australia and New Zealand

Ljuhar, Damir; Little, Tim; King, Sebastian K.; Roberts, Kiera; Rayner, Jessica; Zhao, YouZhi; Rout, Alexandra; Lane, R. S.; Houlton, Adelene; Hyland, Ela; Mishra, Prabal; Tinawi, Georges; Meiyappan, Vivek; Tawhai, Pagan; Greer, Tim

doi:10.1111/ans.17566

Cited by 5 publications

(3 citation statements)

References 24 publications

(40 reference statements)

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“… 20 found no delay in presentation and no significant difference in the rates of complicated appendicitis. Another retrospective study conducted in Australia and New Zealand also concluded no difference in the presentation of symptoms and complication rates, with no delay in presentation to the emergency department 21 .…”

Section: Prevalence and Epidemiology Of Acute Appendicitis In Vulnera...mentioning

confidence: 94%

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A critical appraisal on the treatment of acute appendicitis in pediatric population during the COVID-19 pandemic

Awuah

Mehta

et al. 2023

Annals of Medicine &Amp; Surgery

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Acute appendicitis is one of the most common causes of abdominal pain in children. During the coronavirus disease 2019 (COVID-19) pandemic, a delay in presentation to the emergency department and a higher rate of complicated appendicitis were observed. Traditionally, operative management (laparoscopic or open appendectomy) was thought to be the best treatment strategy for acute appendicitis. However, nonoperative management with antibiotics has gained popularity in managing pediatric appendicitis during the COVID-19 era. The pandemic has posed significant challenges in the management of acute appendicitis. Cancellation of elective appendectomies, delay in seeking care due to fear of contracting COVID-19 infection, and impact of COVID-19 infection in the pediatric population have resulted in higher rates of complications. Furthermore, multiple studies have reported multisystem inflammatory syndrome in children mimicking acute appendicitis, subjecting patients to unnecessary surgery. Therefore, it is imperative to update the treatment guidelines for the management of acute appendicitis in the pediatric population during and after COVID-19 times.

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Section: Prevalence and Epidemiology Of Acute Appendicitis In Vulnera...mentioning

confidence: 94%

“… 36 also reported that 8 out of 10 patients underwent appendectomy. A retrospective study in Australia and New Zealand showed that the management of pediatric acute appendicitis remained the same during the pandemic, when almost all patients underwent laparoscopic appendicectomy 21 .…”

Section: Changes To the Management Of Pediatric Appendicitis During T...mentioning

confidence: 99%

A critical appraisal on the treatment of acute appendicitis in pediatric population during the COVID-19 pandemic

Awuah

Mehta

et al. 2023

Annals of Medicine &Amp; Surgery

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“…A comunidade foi alertada de várias formas sobre a prevenção de contatos e os serviços públicos e as atividades escolares foram restringidas. Houve diversos relatos em vários países de quadros de AA mais complicados tendo em vista o retardo para o acesso ao diagnóstico e ao tratamento da apendicite aguda [1][2][3][4][5][6][7][8][9][10][11] .…”

Section: Introductionunclassified

Influência da pandemia de COVID-19 na apresentação da apendicite aguda e nos resultados cirúrgicos em hospital público de Salvador, Bahia

Almeida,

Araújo

2024

cmbio

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Introdução: nos primeiros meses da pandemia de COVID-19, os pacientes com apendicite aguda (AA) encontraram o sistema de saúde sobrecarregado, pressionado por adaptações, que poderiam comprometer os resultados do tratamento cirúrgico. Por exemplo, a admissão hospitalar de pacientes com maior tempo de evolução da doença e maior uso das apendicectomias abertas. Objetivo; comparar a frequência, a gravidade e os resultados das apendicectomias laparoscópica e aberta em hospital público de referência na cidade de Salvador, estado da Bahia, do período transpandemia de COVID-19 com o período de pré-pandemia. Metodologia: estudo retrospectivo com duas séries de pacientes submetidos à apendicectomia no Hospital Municipal de Salvador (HMS), entre 1º de março de 2019 e 28 de fevereiro de 2020 (pré-pandemia) e de 1º de março de 2020 até 28 de feverreiro de 2021 (primeiro ano transpandemia). A análise incluiu o tempo de evolução de sintomas, a classificação da AA por gravidade assim como os tipos de intervenções e os desfechos. Resultados: foram analisados os dados de 882 pacientes de apendicectomias por AA no HMS: 470 casos no ano anterior (pré-pandemia) e 412 na transpandemia. Do total, 490 (55,6%) apendicectomias laparoscópicas e 392 (44,4%) apendicectomias abertas: na pré-pandemia, foram 307 (65,3%) apendicectomias laparoscópicas, outras 20 (6,0%) convertidas, completando 163 (34,7%) apendicectomias abertas. No primeiro ano transpandemia, foram realizadas 185 (44,9%) apendicectomias laparoscópicas, outras 10 (5,1%) convertidas, compreendendo 227 (55,1%) apendicectomias abertas. As taxas de complicações pós-operatórias foram 38,5% com a cirurgia aberta e 15,7% com a cirurgia laparoscópica. As reoperações foram mais frequentes na cirurgia aberta (11,0% contra 5,5%), como também a mortalidade operatória (2,1% contra 0,4%). A permanência hospitalar foi maior nos casos de apendicectomia aberta, especialmente em idosos e crianças. Conclusão: O impacto da pandemia de COVID-19 produziu mudanças significativas no tempo de evolução de sintomas e no tratamento cirúrgico da AA e estiveram relacionadas com maiores gravidade, taxas de reoperações, tempos de permanência hospitalar e complicações pós-operatórias, relacionadas com o aumento do número de apendicectomias abertas.

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Spontaneous Resolution of Uncomplicated Appendicitis may Explain Increase in Proportion of Complicated Appendicitis During Covid‐19 Pandemic: a Systematic Review and Meta‐analysis

2023

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Background Reports of an increased proportion of complicated appendicitis during the Covid-19 pandemic suggest a worse outcome due to delay secondary to the restrained access to health care, but may be explained by a concomitant decrease in uncomplicated appendicitis. We analyze the impact of the pandemic on the incidences of complicated and uncomplicated appendicitis. Method We did a systematic literature search in the PubMed, Embase and Web Of Science databases on December 21, 2022 with the search terms (appendicitis OR appendectomy) AND (“COVID” OR SARS-Cov2 OR “coronavirus”). Studies reporting the number of complicated and uncomplicated appendicitis during identical calendar periods in 2020 and the pre-pandemic year(s) were included. Reports with indications suggesting a change in how the patients were diagnosed and managed between the two periods were excluded. No protocol was prepared in advance. We did random effects meta-analysis of the change in proportion of complicated appendicitis, expressed as the risk ratio (RR), and of the change in number of patients with complicated and uncomplicated appendicitis during the pandemic compared with pre-pandemic periods, expressed as the incidence ratio (IR). We did separate analyses for studies based on single- and multi-center and regional data, age-categories and prehospital delay. Results The meta-analysis of 100,059 patients in 63 reports from 25 countries shows an increase in the proportion of complicated appendicitis during the pandemic period (RR 1.39, 95% confidence interval (95% CI 1.25, 1.53). This was mainly explained by a decreased incidence of uncomplicated appendicitis (incidence ratio (IR) 0.66, 95% CI 0.59, 0.73). No increase in complicated appendicitis was seen in multi-center and regional reports combined (IR 0.98, 95% CI 0.90, 1.07). Conclusion The increased proportion of complicated appendicitis during Covid-19 is explained by a decrease in the incidence of uncomplicated appendicitis, whereas the incidence of complicated appendicitis remained stable. This result is more evident in the multi-center and regional based reports. This suggests an increase in spontaneously resolving appendicitis due to the restrained access to health care. This has important principal implications for the management of patients with suspected appendicitis.

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Impact of COVID‐19 on appendicitis presentations in children in Australia and New Zealand

Cited by 5 publications

References 24 publications

A critical appraisal on the treatment of acute appendicitis in pediatric population during the COVID-19 pandemic

A critical appraisal on the treatment of acute appendicitis in pediatric population during the COVID-19 pandemic

Influência da pandemia de COVID-19 na apresentação da apendicite aguda e nos resultados cirúrgicos em hospital público de Salvador, Bahia

Spontaneous Resolution of Uncomplicated Appendicitis may Explain Increase in Proportion of Complicated Appendicitis During Covid‐19 Pandemic: a Systematic Review and Meta‐analysis

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