Non-operative Management for Acute Appendicitis During the COVID-19 Pandemic Does Not Increase the Rate of Complications

Patel, Vishal; Ye, Kenny; In, Haejin; Scheinfeld, Meir H.

doi:10.1007/s11605-020-04844-8

Cited by 17 publications

(25 citation statements)

References 6 publications

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“…2 Forest plot for the odds ratio of the NOM application rate before and after COVID-19 the two groups (p = 0.33). Another study by Patel et al 16 found no significant difference in complication rates of NOM in the setting of COVID-19 (1/24) and before COVID-19 (1/6) (p = 0.36). The adoption of NOM as a main treatment strategy during the pandemic did not increase readmission rates significantly as reported by Ganesh et al 13 (9.4% vs 12.5%, p = 0.75) nor increased the length of hospital stay.…”

Section: Comparing Outcomes Of Nom Of Acute Appendicitis Before and Amentioning

confidence: 88%

“…30 This discrepancy may be attributed to the delayed presentation of patients and inclusion of complicated appendicitis in the studies that reported on NOM efficacy in children during the pandemic. 15,21 Individual studies 13,16,17 compared the outcome of NOM during and before COVID-19 and no significant difference in the failure, complication, and 30-day readmission rates was found. Although these were single-center experiences, they may have an implication that the adoption of NOM as a main treatment strategy of acute appendicitis during the pandemic was not associated with a compromise of the short-term efficacy of NOM.…”

Section: Discussionmentioning

confidence: 99%

“…This systematic review included 14 studies [11][12][13][14][15][16][17][18][19][20][21][22][23][24] published in 2020. Five studies were based in the UK, three in USA, two in China, and one in Ireland, Nepal, Israel, and India.…”

Section: Study and Patients' Characteristicsmentioning

confidence: 99%

“…The adoption of NOM as a main treatment strategy during the pandemic did not increase readmission rates significantly as reported by Ganesh et al 13 (9.4% vs 12.5%, p = 0.75) nor increased the length of hospital stay. 13,16 Outcome of NOM in COVID-19 Positive Patients Two studies 15,22 reported on the outcomes of NOM in patients with COVID-19. Overall, seven patients with COVID-19 were treated initially with NOM, with a failure rate of 43% at discharge.…”

Section: Comparing Outcomes Of Nom Of Acute Appendicitis Before and Amentioning

confidence: 99%

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Rate of Application and Outcome of Non-operative Management of Acute Appendicitis in the Setting of COVID-19: Systematic Review and Meta-analysis

Emile

Hamid²,

Khan

et al. 2021

Journal of Gastrointestinal Surgery

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Background Non-operative management (NOM) of acute appendicitis has been assessed in several studies before COVID-19 pandemic. This systematic review aimed to assess the extent of adoption, efficacy, and safety of NOM of acute appendicitis in the setting of COVID-19. Methods This was a PRISMA-compliant systematic review of the literature. Electronic databases and Google Scholar were queried for studies that applied NOM of acute appendicitis during COVID-19. The main outcome measures were the rates of NOM application during the pandemic as compared to the pre-pandemic period, failure and complication rates of NOM. Failure was defined as the need for appendectomy during NOM and complications included development of appendicular mass or abscess. Results Fourteen studies (2140 patients) were included. The male to female ratio was 1.44:1 and median age was 34. Nine hundred fifty-nine (44.8%) patients had a trial of NOM. The weighted mean rate of NOM application was 50.1% (95%CI: 29.8–70.5%). The application of NOM during the pandemic was significantly more likely than its application before COVID-19 (OR = 6.7, p < 0.001). The weight mean failure rate of NOM was 16.4% (95%CI: 9.4–23.4). NOM failure was more likely in children and patients with complicated appendicitis. The weighted mean complication rate after NOM was 4.5% (95%CI: 1.4–7.7). NOM had significantly lower odds for complications than appendectomy (OR = 0.36, p = 0.03). There was no mortality after application of NOM. Conclusion NOM of acute appendicitis in the setting of COVID-19 may be a safe, short-term alternative to surgery with acceptably low failure and complication rates. Supplementary Information The online version contains supplementary material available at 10.1007/s11605-021-04988-1.

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Section: Comparing Outcomes Of Nom Of Acute Appendicitis Before and Amentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Study and Patients' Characteristicsmentioning

confidence: 99%

Section: Comparing Outcomes Of Nom Of Acute Appendicitis Before and Amentioning

confidence: 99%

See 2 more Smart Citations

Rate of Application and Outcome of Non-operative Management of Acute Appendicitis in the Setting of COVID-19: Systematic Review and Meta-analysis

Emile

Hamid²,

Khan

et al. 2021

Journal of Gastrointestinal Surgery

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“…Historically, antibiotic therapy has been used in 40-45% of patients in Europe compared to less than 5% in the United States (7,8); however, this approach has been challenged due to the ongoing "Comparison of Drugs versus Appendectomy" (CODA) trial, which found that early outcomes of medical management of appendicitis, with or without appendicolith, was noninferior to surgery (9). In addition, non-operative management during the COVID-19 pandemic did not increase complications in one center (10), although several questions remain regarding long-term outcomes in these patients. Nevertheless, this approach has been adopted by the American College of Surgeons during the current pandemic and will likely continue (11).…”

Section: Introductionmentioning

confidence: 92%

Appendiceal Adenocarcinoma Found by Surgery for Acute Appendicitis is Associated with Older Age

Alemany

Skendelas

et al. 2021

Preprint

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Background: Appendectomy for acute appendicitis is the most common procedure performed emergently by general surgeons in the United States. The current management of acute appendicitis is increasingly controversial as non-operative management gains favor. Although rare, appendiceal neoplasms are often found as an incidental finding in the setting of appendectomy. Criteria and screening for appendiceal neoplasms are not standardized among surgical societies. Methods: The National Surgical Quality Improvement Program (NSQIP) database was queried for all patients with who underwent appendectomy over a nine-year period (2010-2018). Over the same time, patients who underwent appendectomy in two municipal hospitals in The Bronx, New York City, USA were reviewed. Results: We found a 1.7% incidence of appendiceal neoplasms locally and a 0.53% incidence of appendiceal tumors in a national population sample. Both groups demonstrated an increased incidence of appendiceal carcinoma by age. This finding was most pronounced after the age of 40 in both local and national populations. In our study, the incidence of appendiceal tumors increased with each decade interval up to the age of 80 and peaked at 2.1% in patients between 70 and 79 years. Conclusions: Appendiceal adenocarcinomas were identified in patients with acute appendicitis that seem to be associated with increasing age. The presence of an appendiceal malignancy should be considered in the management of older patients with acute appendicitis before a decision to embark on non-operative therapy.

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

Ceresoli

Coccolini

Magnone

et al. 2021

Eur J Trauma Emerg Surg

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Background During pandemic, admissions for surgical emergencies dropped down dramatically. Also acute appendicitis decreased. The aim of the present study was to evaluate the change in volume and clinical presentation of patients with acute appendicitis during pandemic and the variation in treatment. Methods This is a retrospective study of patients admitted in 11 Italian hospital for acute appendicitis during the lockdown period (March–April 2020) compared with the same period of the previous 2 years (2018–2019). The number and the rate of complicated and non-complicated acute appendicitis were recorded and compared between the two study periods; non-operative vs operative treatment and negative appendectomy rate were also recorded. Results The study included 532 patients, 112 in the study period and 420 in the control period; Hospital admission for acute appendicitis dropped by 46% (OR 0.516 95% CI 0.411–0.648 p < 0.001) during the 2020 lockdown. The number of complicated acute appendicitis did not change (− 18%, OR 0.763 95% CI 0.517–1.124 p = 0.1719), whereas the number of non-complicated acute appendicitis significantly decreased (− 56%, OR 0.424 95% CI 0.319–0.564 p < 0.001). Non-operative treatment rate remained similar (12.1% vs. 11.6% p = 0.434). The negative appendectomy rate also significantly decreased (6.1% vs. 17.3%, p = 0.006). Conclusions The present study found a significant reduction of both admissions for non-complicated acute appendicitis and negative appendectomy rate during the pandemic period. Conversely, admissions for complicated acute appendicitis did not change. Trial registration: NCT04649996.

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Non-operative Management for Acute Appendicitis During the COVID-19 Pandemic Does Not Increase the Rate of Complications

Cited by 17 publications

References 6 publications

Rate of Application and Outcome of Non-operative Management of Acute Appendicitis in the Setting of COVID-19: Systematic Review and Meta-analysis

Rate of Application and Outcome of Non-operative Management of Acute Appendicitis in the Setting of COVID-19: Systematic Review and Meta-analysis

Appendiceal Adenocarcinoma Found by Surgery for Acute Appendicitis is Associated with Older Age

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

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