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

Abstract

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.

Acute Abdomen and Appendicitis in 1010 Pediatric Patients With COVID-19 or MIS-C: A Multinational Experience from Latin America

“…About the management of AA, 81% of our patients underwent surgery as the preferred modality of treatment; this differs from the practice reported in some hospitals that suggest conservative management of patients with the diagnosis of SARS-CoV-2 and acute abdomen. 6 , 7 Some centers have used more conservative approaches for uncomplicated cases of AA in patients with COVID-19, including home care and nonoperative management with antibiotics. 23 …”

“… 5 In the context of COVID-19, nonoperative management of AA is an alternative to surgery with low failure and complication rates. 6 …”

The effect of the Covid-19 outbreak on the management of acute appendicitis: A retrospective comparative cohort study

“…The management of acute appendicitis involves, if possible, conservative treatment as an outpatient, short hospitalization, operation with an open technique and under regional anesthesia [16]. AA was managed conservatively in 5.4-22.2% of the patients during the prepandemic period, which increased to 7.8-100% during the pandemic [30]. In our study, conservative treatment was performed in 46.8% (36/77) of the AA patients with 5.5% (n=2) recurrence rate during the pandemic.…”

Management of Acute Appendicitis in Children During COVID-19 and Perspectives of Pediatric Surgeons From South Asia: Survey Study

“…More recently, the usage of NOT and the resulting outcomes of AUA in the setting of COVID-19 was systematically reviewed. The results indicated that NOT was a safe, short-term alternative to surgery and led to acceptably low rates of failure and complication [ 29 ]. However, a global study on the effect of COVID-19 on pediatric surgery, in general, showed less of an effect, where only 4 out of 20 institutes were found to begin using NOT for appendicitis, and 14 out of 20 reported that they had not changed their extent of NOT use [ 30 ].…”