More Severe Presentations of Acute Appendicitis During COVID-19

Angeramo, Cristian A.; Dreifuss, Nicolás H; Schlottmann, Francisco; Rotholtz, Nicolás A.

doi:10.1007/s11605-020-04892-0

Cited by 18 publications

(24 citation statements)

References 7 publications

(8 reference statements)

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“…We believe that this did have an impact on the patients as observed by a lower rate of perforations (although without significance), postoperative complications, and the same length of stay at the hospital, which was the same in both time periods-6 days. This was contradicting to many other reports online, where a higher duration of symptoms up to ER was observed both in adult patients and children, which may explain the higher rate of perforation and complicated appendicitis cases, as time is an important factor in the development of perforation; however, they do not measure the time from the ER to the department and to the OR [23,[28][29][30][33][34][35][36]. Another factor that has importance in the development of complicated appendicitis and perforations could be overconfidence in the non-operative treatment method, which has been used more widely during the pandemic in some countries such as UK, Spain, and the US [35,[37][38][39].…”

Section: Discussioncontrasting

confidence: 75%

“…Due to the fact of self-medication, telemedicine, and fear of contracting the virus, we expected patients to seek help much later than the year prior and expected an increase of time from the beginning of symptoms to ER and OR as well as an increased number of perforations or complicated appendicitis cases due to a longer course of disease, as observed in most other countries, except single studies in China, the US, Turkey, and Italy, and more in children than adults [14,19,[23][24][25][26][27][28][29][30][31][32]. We however did not observe a difference in complicated appendicitis rates-35.7% of all appendicitis cases in 2019 with a slightly, but not statistically significant, smaller number observed in 2020 during the pandemic of 32.7%.…”

Section: Discussionmentioning

confidence: 99%

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Did the COVID-19 Pandemic Prolong the Time Till Diagnosis and Worsen Outcomes for Children with Acute Appendicitis?

et al. 2021

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Background and Objectives: Our aim was to see if the COVID-19 pandemic led to an increase of time until diagnosis, operation, and time spent in Emergency room (ER), and if it resulted in more cases of complicated appendicitis and complication rates in children. Materials and Methods: We conducted a retrospective analysis of patients admitted to the Pediatric Surgery Department with acute appendicitis during a 4-month period of the first COVID-19 pandemic and compared it to the previous year data—the same 4-month period in 2019. Results: During the pandemic, the time spent in the ER until arriving at the department increased significantly 2.85 vs. 0.98 h p < 0.001, and the time spent in the department until the operation 5.31 vs. 2.66 h, p = 0.03. However, the time from the beginning of symptoms till ER, operation time and the length of stay at the hospital, as well as the overall time until operation did not differ and did not result in an increase of complicated appendicitis cases or postoperative complications. Conclusions: The COVID-19-implemented quarantine led to an increase of the time from the emergency room to the operating room by 4 h. This delay did not result in a higher rate of complicated appendicitis and complication rates, allowing for surgery to be postponed to daytime hours if needed.

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Section: Discussioncontrasting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Did the COVID-19 Pandemic Prolong the Time Till Diagnosis and Worsen Outcomes for Children with Acute Appendicitis?

et al. 2021

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“…Overall 25.581 patients were analysed: 18,107 before the onset of the pandemic and 7474 during the pandemic [ 16 , 18 , 20 , [23] , [24] , [25] , [26] , [27] , 30 , 31 , [34] , [35] , [36] , 41 , [54] , [55] , [56] , [57] , [58] , [59] ]. During the pandemic 26.6% of patients had complicated appendicitis, compared to 22.2% before the onset of the pandemic.…”

Section: Resultsmentioning

confidence: 99%

“…18 studies [ 11 , 16 , 18 , 24 , 26 , 27 , 30 , 31 , 35 , [39] , [40] , [41] , [53] , [54] , [55] , [56] , [57] , [58] ] described the length of hospital stay (in days) in adults before and during the COVID-19 pandemic.…”

Section: Resultsmentioning

confidence: 99%

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Changes in appendicitis treatment during the COVID-19 pandemic – A systematic review and meta-analysis

Köhler

Müller

Hendricks

et al. 2021

International Journal of Surgery

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Background During the COVID-19 pandemic in 2020 a decrease of emergency consultations and modification in treatment of numerous medical conditions were observed. Aim of this paper was to evaluate the effect of the COVID-19 pandemic on incidence, treatment strategies, severity, length of hospital stay and time of presentation in adults and children with acute appendicitis. Methods A systematic literature search of Pubmed, Embase and Cochrane databases was performed, and eligible studies used to perform a meta-analysis. Results 46 suitable studies were identified with an overall reduction of appendicitis cases by 20.9% in adults and an increase of 13.4% in children. The rate of open appendectomies increased without statistical significance in both groups (adults: 8.5% vs. 7.1%, P = 0.32; children: 7.1% vs. 5.3%, P = 0.13), whereas the rate of antibiotic treatment increased significantly (P = 0.007; P = 0.03). Higher rates of complicated appendicitis were observed in adults (adults: OR 2.00, P < 0.0001; children: OR 1.64, P = 0.12). Time to first consultation did not change significantly (adults: 52.3 vs. 38.5 h – P = 0.057; children: 51.5 vs. 32.0 h – P = 0.062) and length of stay was also not lengthened during the pandemic (adults: 2.9 vs. 2.7 days, P = 0.057; children: 4.2 vs. 3.7 days, P = 0.062). Conclusion The COVID-19 pandemic of 2020 had major impact on incidence and treatment strategies of acute appendicitis. Results of this meta-analysis might be another hint to support the theory that appendicitis is not a progressive disease and surgeons can safely consider antibiotic therapy for acute uncomplicated appendicitis.

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Author´s Reply: Conversion from Laparoscopic to Open Appendectomy: Trends, Risk Factors and Outcomes. A 15‐year single‐center analysis of 2193 patients

Lezama

Schlottmann

2023

World j. surg.

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More Severe Presentations of Acute Appendicitis During COVID-19

Cited by 18 publications

References 7 publications

Did the COVID-19 Pandemic Prolong the Time Till Diagnosis and Worsen Outcomes for Children with Acute Appendicitis?

Did the COVID-19 Pandemic Prolong the Time Till Diagnosis and Worsen Outcomes for Children with Acute Appendicitis?

Changes in appendicitis treatment during the COVID-19 pandemic – A systematic review and meta-analysis

Author´s Reply: Conversion from Laparoscopic to Open Appendectomy: Trends, Risk Factors and Outcomes. A 15‐year single‐center analysis of 2193 patients

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