The Impact of the Coronavirus Disease - 19 Pandemic on the Clinical Characteristics and Treatment of Adult Patients with Acute Appendicitis

An, Sang Hyun; Kim, Hae-Rim; Jang, Sungwoo; Kim, Kwangmin

doi:10.3389/fsurg.2022.878534

Cited by 4 publications

(11 citation statements)

References 37 publications

(44 reference statements)

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“…Patients undergoing operative management for appendicitis during the pandemic were assessed to have poorer overall health, as determined by their significantly higher ASA scores. This was not identified in other studies, which all reported no significant difference between the pandemic and control cohort ASA scores [ 37 , 38 , 42 ]. There are a number of explanations why our findings differed from other studies; the studies were conducted in different countries with differing health care systems, and the ASA is a subjective measure.…”

Section: Discussioncontrasting

confidence: 56%

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

et al. 2022

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Background The Coronavirus Disease 2019 (COVID-19) pandemic profoundly impacted delivery of health care. South Western Sydney Local Health District (SWSLHD) experienced some of the highest cases, admissions and deaths during the Delta and Omicron waves in New South Wales. This study aims to determine the impact of the pandemic on emergency surgery services for adults presenting with acute appendicitis. Methods A retrospective review of patient records was performed of adults presenting with acute appendicitis between 1st March 2021 and 31st March 2022, which was compared to a pre-COVID control period of the same dates in 2019–2020. Patients managed operatively or conservatively were included. Results 1556 patients were included in the operative arm; 723 and 833 respectively in the study and control groups, which were comparable at baseline. 1.66% were COVID positive. During the pandemic, patients were significantly more likely to be investigated with computered tomography (CT) scan (p ≤ 0.001), present with complicated appendicitis (p = 0.03), and require caecectomy (p = 0.005). They had higher American Society of Anaesthesiology (ASA) scores (p = 0.001) and significantly lower negative appendectomy rates (p = 0.001). Fifty-two patients were included in the conservative arm; 29 and 23 respectively in the pandemic and control groups. Patients were comparable at baseline. There were two COVID positive patients. During the pandemic, there was a significant reduction in complications (p = 0.033), readmissions (0.044) and interval appendicectomy (p = 0.0044). Conclusion We identified higher rates of complicated appendicitis, caecectomies and greater reliance on CT imaging preoperatively during the pandemic in SWSLHD.

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Section: Discussioncontrasting

confidence: 56%

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

et al. 2022

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“…Although some studies have shown higher complicated appendicitis during the COVID-19 outbreak [ 2 , 16 , 18 , 21 , 42 , 43 ] along with a higher complication rate [ 2 , 7 , 35 ] of statistical significance, our study showed no statistically significant complicated appendicitis or complication rate during the COVID-19 outbreak. Even with significantly longer waiting times for surgery, a well-prepared healthcare system managed to maintain a standard of care during the pandemic.…”

Section: Discussioncontrasting

confidence: 89%

“…[7,16,17] We found no statistical signifcance of longer self-reported symptom period but there was the statistical signifcance of higher ASA classifcation, concomitant with airway and chronic kidney disease, higher pulse rate, respiratory rate, and neutrophil predominate that indicated systemic infammatory response and more severe disease. Te lower number of patients with acute appendicitis in the during COVID-19 group [18][19][20] may be due to Emergency Medicine International the patient being afraid of in-hospital COVID-19 transmission [21,22], so the increased threshold presenting to the hospital, a mild symptom of acute appendicitis may spontaneously regress without treatment or patients may have gone to the drug store and taken oral antibiotics by themselves and then symptoms resolved without the need of hospital treatment [18,[23][24][25] together with the strong government policy of stay-at-home. Te gastrointestinal presenting symptoms of COVID-19 infection mimic the symptoms of acute appendicitis [26][27][28] caused by multisystem infammatory syndrome (MIS), especially in children and adolescents.…”

Section: Discussionmentioning

confidence: 99%

The Impact of the COVID-19 Pandemic on the Incidence, Severity, and Management of Acute Appendicitis: A Single Center Experience in Thailand

Achavanuntakul

Mahawongkajit

Orrapin

et al. 2022

Emergency Medicine International

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Purpose. For more than two years since the COVID-19 pandemic, human lives have changed, including the healthcare system. Management of acute appendicitis, the most common emergency surgical disease, has been inevitably affected. This study aimed to assess the effect of the COVID-19 pandemic on the incident rate of complicated appendicitis, management, outcome, and complication of acute appendicitis. Patients and Methods. This study was a retrospective cohort study comparing 574 patients diagnosed with acute appendicitis before the COVID-19 outbreak and 434 patients diagnosed with acute appendicitis during the COVID-19 outbreak. Patient demographic data, type of appendicitis, type of treatment, time to surgery, length of stay, cost, and complications were collected and analyzed. Results. During the COVID-19 pandemic, the number of patients diagnosed with acute appendicitis was reduced. CT scan usage for diagnosis was increased compared to pre-COVID-19. Most patients diagnosed with acute appendicitis received operative treatment in both groups. Median time to surgery was significantly longer during the COVID-19 pandemic, 11.93 hours compared to 9.62 hours pre-COVID-19, p -value <0.001 (relative risk 1.5, 95% CI 1.29–1.76, p value 0.041). The incidence of complicated appendicitis was not higher during COVID-19. Compared to pre-COVID-19, ICU admission rate, the use of a mechanical ventilator, length of stay, and cost increased in the univariate analysis but were not statistically significant in the multivariate analyses. Other treatment complications had no statistically significant difference. Conclusion. The incidence of complicated appendicitis did not increase during the COVID-19 pandemic. The operation waiting time significantly increased but did not increase the rate of treatment complications in a well-prepared hospital system.

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“…This suggests that there was no tendency to delay visits to the emergency department due to fear of infection. In contrast, several studies have reported prolonged times to hospital visits from symptom onset during the pandemic [ 2 16 18 19 ]. They suggested that the reason for this delay is patient concern about COVID-19 transmission at the hospital.…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on the outcomes of laparoscopic appendectomy for acute appendicitis

Kim

Kang

2023

Ann Surg Treat Res

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Purpose This retrospective study aimed to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the time interval from symptom onset to surgery and on the operative outcomes of laparoscopic appendectomy for patients with acute appendicitis. Methods Between October 2018 and July 2021, laparoscopic appendectomy was performed in 502 patients with acute appendicitis admitted to Hallym University Chuncheon Sacred Heart Hospital in Chuncheon, Korea. We compared demographic data, serum levels of inflammatory markers, time to event of appendicitis, and operative outcomes between the pre-COVID-19 and post-COVID-19 pandemic groups. Results Laparoscopic appendectomy was performed in 271 patients in the pre-COVID-19 group and in 231 patients in the post-COVID-19 group. There were no differences in baseline characteristics, serum inflammatory marker levels, or the proportions of complicated appendicitis between the groups (25.1%, pre-COVID-19 vs. 31.6%, post-COVID-19; P = 0.106). The time intervals between symptom onset and hospital arrival (24.42 hours vs. 23.59 hours, P = 0.743) and between hospital arrival and the start of surgery (10.12 hours vs. 9.04 hours, P = 0.246) did not increase post-COVID-19. The overall 30-day postoperative complication rate did not differ significantly between the groups (9.6% vs. 10.8%, P = 0.650), and the severity of 30-day postoperative complications was also similar in both groups (P = 0.447). Conclusion This study demonstrates that hospitalization and surgeries were not delayed in patients with acute appendicitis and that the operative outcomes of laparoscopic appendectomy did not worsen despite the COVID-19 pandemic.

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The Impact of the Coronavirus Disease - 19 Pandemic on the Clinical Characteristics and Treatment of Adult Patients with Acute Appendicitis

Cited by 4 publications

References 37 publications

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

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

The Impact of the COVID-19 Pandemic on the Incidence, Severity, and Management of Acute Appendicitis: A Single Center Experience in Thailand

Impact of the COVID-19 pandemic on the outcomes of laparoscopic appendectomy for acute appendicitis

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