Presentation and outcomes of acute appendicitis during COVID-19 pandemic: lessons learned from the Middle East—a multicentre prospective cohort study

Abstract

Background The coronavirus disease 2019 (COVID-19) pandemic had a striking impact on healthcare services in the world. The present study aimed to investigate the impact of the COVID-19 pandemic on the presentation management and outcomes of acute appendicitis (AA) in different centers in the Middle East. Methods This multicenter cohort study compared the presentation and outcomes of patients with AA who presented during the COVID-19 pandemic in comparison to patients who presented before the onset of the pandemic. Demographic data, clinical presentation, management strategy, and outcomes were prospectively collected and compared. Results Seven hundred seventy-one patients presented with AA during the COVID pandemic versus 1174 in the pre-COVID period. Delayed and complex presentation of AA was significantly more observed during the pandemic period. Seventy-six percent of patients underwent CT scanning to confirm the diagnosis of AA during the pandemic period, compared to 62.7% in the pre-COVID period. Non-operative management (NOM) was more frequently employed in the pandemic period. Postoperative complications were higher amid the pandemic as compared to before its onset. Reoperation and readmission rates were significantly higher in the COVID period, whereas the negative appendicectomy rate was significantly lower in the pandemic period (p = 0.0001). Conclusion During the COVID-19 pandemic, a remarkable decrease in the number of patients with AA was seen along with a higher incidence of complex AA, greater use of CT scanning, and more application of NOM. The rates of postoperative complications, reoperation, and readmission were significantly higher during the COVID period.

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

“…In our cohort, the negative appendicectomy rate nearly halved during the pandemic to 5.7%, whilst the rate of CT prior to operation increased by approximately 10%. Studies during the pandemic also noted the same significant reduction in negative appendicectomy, and have reported a rate as low as 0% [ 23 , 25 , 26 , 29 ]. Their studies also identified higher rates of CT use.…”

“…This study identified there was a statistically significant reduction in clinical diagnosis of appendicitis during the pandemic; patients presenting prior to the pandemic were twice as likely to be managed based on their clinical presentation. Greater use of CT to diagnose appendicitis during the pandemic was also reported in the United Kingdom [ 23 , 24 ], Ireland [ 25 ], Middle East [ 26 ] and Turkey [ 27 ]. These studies have reported greater utilisation of CT ranging from increases of 21–123%.…”

Estimating the potential overdiagnosis and overtreatment of acute appendicitis in Thailand using a secondary data analysis of service utilization before, during and after the COVID-19 lockdown policy

“…During the COVID-19 pandemic, countries such as China, Egypt and Saudi Arabia observed an overall decrease in total number of patients with acute appendicitis alongside a concurrent increase in complications, such as gangrene or perforation [ 12 – 14 ]. We therefore hypothesise that diagnosis and treatment of cases during the pandemic was restricted to essential procedures only.…”

To Compare the Outcome of Conservative Management Versus Open Appendicectomy in Early Presentation of Acute Appendicitis in Children during Covid-19 Pandemic

“…Additionally, surgical capacity has been diminished due to the redeployment of surgical professionals to critical care and medical ward settings in order to deal with the unprecedented demands of COVID-19. The Royal College of Surgeons in England (RCSEng) published national recommendations after the initial pandemic outbreak to reduce the use of surgery in favour of more conservative methods of treatment [11,12]. Patients presenting with AA in the United Kingdom during the initial wave of the pandemic were instead handled conservatively when they would have ordinarily required surgery.…”