Management of acute appendicitis during the COVID-19 pandemic: a retrospective cohort study

Abstract

Background The Coronavirus Disease 2019 (COVID-19) pandemic profoundly impacted delivery of health care. South Western Sydney Local Health District (SWSLHD) experienced some of the highest cases, admissions and deaths during the Delta and Omicron waves in New South Wales. This study aims to determine the impact of the pandemic on emergency surgery services for adults presenting with acute appendicitis. Methods A retrospective review of patient records was performed of adults presenting with acute appendicitis between 1st March 2021 and 31st March 2022, which was compared to a pre-COVID control period of the same dates in 2019–2020. Patients managed operatively or conservatively were included. Results 1556 patients were included in the operative arm; 723 and 833 respectively in the study and control groups, which were comparable at baseline. 1.66% were COVID positive. During the pandemic, patients were significantly more likely to be investigated with computered tomography (CT) scan (p ≤ 0.001), present with complicated appendicitis (p = 0.03), and require caecectomy (p = 0.005). They had higher American Society of Anaesthesiology (ASA) scores (p = 0.001) and significantly lower negative appendectomy rates (p = 0.001). Fifty-two patients were included in the conservative arm; 29 and 23 respectively in the pandemic and control groups. Patients were comparable at baseline. There were two COVID positive patients. During the pandemic, there was a significant reduction in complications (p = 0.033), readmissions (0.044) and interval appendicectomy (p = 0.0044). Conclusion We identified higher rates of complicated appendicitis, caecectomies and greater reliance on CT imaging preoperatively during the pandemic in SWSLHD.

Impact of the COVID-19 Pandemic on the Severity and Early Postoperative Outcomes of Acute Appendicitis

“…An et al recognized the median duration of symptoms before admission was six hours longer during the pandemic compared to the pre-pandemic period (18 vs. 24 hours) [6]. Meanwhile, Tankel et al and Francombe et al did not find any significant difference in the duration of symptoms (1.5 vs. 1.8 days, and 2.2 vs 2.3 days, respectively) [10,19].…”

“…Coronavirus disease 2019 (COVID- 19) is the name of an infectious condition caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which was first identified in the beginning of 2020 in China. After being declared by the World Health Organization (WHO) as a pandemic on March, 11th 2020, the COVID-19 pandemic rapidly spread and profoundly influenced healthcare systems worldwide [1,2].…”

Is nonoperative management of appendicitis inferior in the COVID-19 era?

“…Pandemic studies have conflicting results on symptom duration before presentation, 24,25,29 but most have found a higher rate of complicated appendicitis during the pandemic. 24,32 In our study, 42% of patients presented with complicated appendicitis, which agrees with published literature of more advanced presentations during the pandemic.…”

“…In fact, Forssten et al 28 reported no difference in American Society for Anesthesiologist physical status class between COVID groups, with the majority being American Society for Anesthesiologist class 1 or 2. In addition, Frankcombe et al 29 reported that 12 asymptomatic COVID-positive patients underwent appendectomy for AA without adverse outcomes. Together, these results suggest that a positive COVID-19 test alone should not exclude patients from appendectomy for AA.…”

Were surgical outcomes for acute appendicitis impacted by the COVID-19 pandemic?

“…The standard of care for acute appendicitis is generally considered to be laparoscopic appendectomy, although with some consideration of antibiotic therapy as a potential treatment for certain indications [9][10][11][12]. There has been significant interest surrounding the effects of the COVID-19 pandemic on volume, severity, and treatment of acute appendicitis, with evidence supporting an increase in the rate of antibiotic treatment for acute appendicitis during the pandemic as well as higher rates of complicated and perforated appendicitis observed in adults [10,[13][14][15][16][17][18]. Additionally, as society continues to adapt to live with COVID as a potentially permanent part of the healthcare landscape, there has been little research into how the continued adaptions around COVID-19 affect how surgical systems function today.…”