The impact of COVID-19 pandemic lockdown on the incidence and outcome of complicated appendicitis

Rudnicki, Yaron; Soback, Hagai; Mekiten, Ori; Lifshiz, Guy; Avital, Shmuel

doi:10.1007/s00464-021-08667-9

Cited by 17 publications

(28 citation statements)

References 19 publications

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“…There are various criteria that can be used to define complicated appendicitis, such as preoperative imaging studies, pathological results and surgeon's subjective opinions based on intraoperative findings (Gomes' laparoscopic grading system) [31][32][33]. Imaging studies and surgeon opinion criteria could not be used due to insufficient data in this retrospective study.…”

Section: Discussionmentioning

confidence: 99%

Clinical Experience of Emergency Appendectomy under the COVID-19 Pandemic in a Single Institution in South Korea

Choi

Chung

et al. 2022

Medicina

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Background and Objectives: The COVID-19 pandemic has brought serious changes in healthcare systems worldwide, some of which have affected patients who need emergency surgery. Acute appendicitis is the most common surgical disease requiring emergency surgery. This study was performed to determine how the COVID-19 pandemic has changed the treatment of patients with acute appendicitis in South Korea. Materials and Methods: We retrospectively reviewed a medical database that included patients who underwent surgery for acute appendicitis in our hospital from January 2019 to May 2021. We classified the patients into two groups according to whether they were treated before or after the COVID pandemic and 10 March 2020 was used as the cutoff date, which is when the World Health Organization declared the COVID pandemic. Results: A total of 444 patients were included in the “Pre-COVID-19” group and 393 patients were included in the “COVID-19” group. In the “COVID-19” group, the proportion of patients with severe morbidity was significantly lower. The time that the patients spent in the emergency room before surgery was significantly longer in the ”COVID-19” group (519.11 ± 486.57 min vs. 705.27 ± 512.59 min; p-value < 0.001). There was no difference observed in the severity of appendicitis or in the extent of surgery between the two groups. Conclusions: During the COVID-19 pandemic, a statistically significant time delay (186.16 min) was needed to confirm COVID-19 infection status. However, there was no clinical difference in the severity of appendicitis or in the extent of surgery. To ensure the safety of patients and medical staff, a COVID-19 PCR test should be performed.

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Section: Discussionmentioning

confidence: 99%

Clinical Experience of Emergency Appendectomy under the COVID-19 Pandemic in a Single Institution in South Korea

Choi

Chung

et al. 2022

Medicina

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“…Gao et al [ 2 ] stated that prolonged pre-hospital intervals (OR: 1.075; P = 0.005) and reluctance of patients towards the recommended surgical/medical therapy (OR: 1.848; P = 0.007) were independent risk factors for increased rates of complicated AAp. Similarly, Rudnick et al [ 17 ] found that prolongation of the interval between initiation of symptoms and hospital admission was an independent risk factor for development of complicated AAp (OR: 1.139; P = 0.032). In various other studies it was reported that there was no statistically significant difference in the pre-admission intervals between the pandemic and pre-pandemic periods[ 18 , 19 , 22 , 37 ].…”

Section: Discussionmentioning

confidence: 86%

“…This may be due to hesitation of the patients to seek medical help or may be related with overwhelmed hospitals that could not provide the necessary medical care for these patients. Twenty-five studies have been evaluated COVID-19 and AAp, and six of these studies stated that the interval between the initiation of symptoms and hospital admission had been prolonged[ 1 , 2 , 4 , 15 , 17 , 36 ]. Particularly, in 2 of these 6 studies, this difference in pre-admission intervals during the COVID-19 pandemic was evaluated and confirmed with different regression models.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with AAp had delayed hospital admissions and majority of these patients preferred nonoperative treatments such as antibiotic therapy during the pandemic[ 2 , 9 , 12 - 16 ]. Studies have reported that a delay in hospital admissions of patients with AAp have led to increased complication rates[ 2 , 17 ]. There are also contradictory studies that show that hospital admissions did not show significant differences during the COVID-19 pandemic[ 18 - 22 ].…”

Section: Introductionmentioning

confidence: 99%

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Effect of the COVID-19 pandemic on patients with presumed diagnosis of acute appendicitis

Akbulut¹,

Tunçer²,

Ogut³

et al. 2022

World J Clin Cases

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BACKGROUND Acute appendicitis (AAp) is the most frequent cause of acute abdominal pain, and appendectomy is the most frequent emergency procedure that is performed worldwide. The coronavirus disease 2019 (COVID-19) pandemic has caused delays in managing diseases requiring emergency approaches such as AAp and trauma. AIM To compare the demographic, clinical, and histopathological outcomes of patients with AAp who underwent appendectomy during pre-COVID-19 and COVID-19 periods. METHODS The demographic, clinical, biochemical, and histopathological parameters were evaluated and compared in patients who underwent appendectomy with the presumed diagnosis of AAp in the pre-COVID-19 (October 2018-March 2020) and COVID-19 (March 2020-July 2021) periods. RESULTS Admissions to our tertiary care hospital for AAp increased 44.8% in the COVID-19 period. Pre-COVID-19 ( n = 154) and COVID-19 ( n = 223) periods were compared for various parameters, and we found that there were statistically significant differences in terms of variables such as procedures performed on the weekdays or weekends [odds ratio (OR): 1.76; P = 0.018], presence of AAp findings on ultrasonography (OR: 15.4; P < 0.001), confirmation of AAp in the histopathologic analysis (OR: 2.6; P = 0.003), determination of perforation in the appendectomy specimen (OR: 2.2; P = 0.004), the diameter of the appendix ( P < 0.001), and hospital stay ( P = 0.003). There was no statistically significant difference in terms of interval between the initiation of symptoms and admission to the hospital between the pre-COVID-19 (median: 24 h; interquartile range: 34) and COVID-19 (median: 36 h; interquartile range: 60) periods ( P = 0.348). The interval between the initiation of symptoms until the hospital admission was significantly longer in patients with perforated AAp regardless of the COVID-19 or pre-COVID-19 status ( P < 0.001). CONCLUSION The present study showed that in the COVID-19 period, the ultrasonographic determination rate of AAp, perforation rate of AAp, and duration of hospital stay increased. On the other hand, negative appendectomy rate decreased. There was no statistically significant delay in hospital admissions that would delay the diagnosis of AAp in the COVID-19 period.

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“…Most of the studies describing more severe cases of appendicitis focus on the early periods of the pandemic, and often include some 60 patients only for the study period. 14 , 15 , 23 , 24 These findings are usually explained by a delay in consulting the emergency department, 15 or because patients with mild appendicitis may hesitate to seek help. 25 Although studies based on claims data from German insurance companies demonstrate a significantly reduced number of appendectomies, this drop affected mostly simple acute and non-acute appendicitis, but not complicated acute appendicitis.…”

Section: Discussionmentioning

confidence: 99%

Access to Surgery and Quality of Care for Acute Cholecystitis During the COVID-19 Pandemic in 2020 and 2021 — an Analysis of 12,545 Patients from a German-Wide Hospital Network

Siegel

Hohenstein

Anders

et al. 2022

Journal of Gastrointestinal Surgery

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Purpose To determine effects on admission, treatment, and outcome for acute cholecystitis during the course of the COVID-19 pandemic in 2020 and 2021. Methods Retrospective analysis of claims data from 74 German hospitals. Study periods were defined from March 5, 2020 (start of first wave) to June 20, 2021 (end of third wave) and compared to corresponding control periods (March 2018 to February 2020). All in-patients with acute cholecystitis were included. Distribution of cases, type of surgery, comorbidities, surgical outcome, and length of stay of all cases with acute cholecystitis and cholecystectomy were compared. In addition, we analyzed the type of treatment (non-surgical, cholecystostomy, or cholecystectomy) for all cases with main diagnosis of acute cholecystitis. Results We could not demonstrate differences in daily admissions over the course of the pandemic (11.2–12.7 patients vs. 11.9–12.6 patients for control periods). Proportion of patients with non-surgical treatment was low and not increased (11.7–17.3% vs. 14.5–18.4%). Cholecystostomy was rare throughout all periods (0–0.5% of all patients). We did not observe an increase in open surgery (proportion of open cholecystectomies 3.4–5.5%). Mortality was generally low (1.5–1.9%) with no differences between periods. Median length of stay was 4 days throughout all periods. Conclusion The numerous restrictions during the COVID-19 pandemic did not result in an increase of admissions or surgery for acute cholecystitis. Laparoscopic cholecystectomy has been safely applied during the pandemic. Our results may assure the ability to maintain high quality of surgical care even in times of disruptions to the health care system. Supplementary Information The online version contains supplementary material available at 10.1007/s11605-022-05318-9.

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The impact of COVID-19 pandemic lockdown on the incidence and outcome of complicated appendicitis

Cited by 17 publications

References 19 publications

Clinical Experience of Emergency Appendectomy under the COVID-19 Pandemic in a Single Institution in South Korea

Clinical Experience of Emergency Appendectomy under the COVID-19 Pandemic in a Single Institution in South Korea

Effect of the COVID-19 pandemic on patients with presumed diagnosis of acute appendicitis

Access to Surgery and Quality of Care for Acute Cholecystitis During the COVID-19 Pandemic in 2020 and 2021 — an Analysis of 12,545 Patients from a German-Wide Hospital Network

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