Urgent and emergency surgery for secondary peritonitis during the COVID-19 outbreak: an unseen burden of a healthcare crisis

Fallani, Guido; Lombardi, Raffaele; Masetti, Michele; Chisari, Mario; Zanini, Nicola; Cattaneo, G; Filosa, Mauro; Zanzi, Federico; Guerra, Enrico; Bonilauri, Stefano; Donato, Laura; Garulli, Gianluca; Lucchi, Andrea; Grassia, Michele; Ugolini, Giampaolo; Pasini, Francesco; Vetrone, Gaetano; Benini, Claudia; Nicosia, S; Jovine, Elio

doi:10.1007/s13304-020-00943-y

Cited by 14 publications

(9 citation statements)

References 25 publications

(18 reference statements)

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“…26 studies described a change in case number of appendicitis and/or appendectomies between comparable time periods before and during the COVID-19 pandemic in adults [ [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] ]. Studies were conducted in 15 countries (as shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

Changes in appendicitis treatment during the COVID-19 pandemic – A systematic review and meta-analysis

Köhler

Müller

Hendricks

et al. 2021

International Journal of Surgery

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Background During the COVID-19 pandemic in 2020 a decrease of emergency consultations and modification in treatment of numerous medical conditions were observed. Aim of this paper was to evaluate the effect of the COVID-19 pandemic on incidence, treatment strategies, severity, length of hospital stay and time of presentation in adults and children with acute appendicitis. Methods A systematic literature search of Pubmed, Embase and Cochrane databases was performed, and eligible studies used to perform a meta-analysis. Results 46 suitable studies were identified with an overall reduction of appendicitis cases by 20.9% in adults and an increase of 13.4% in children. The rate of open appendectomies increased without statistical significance in both groups (adults: 8.5% vs. 7.1%, P = 0.32; children: 7.1% vs. 5.3%, P = 0.13), whereas the rate of antibiotic treatment increased significantly (P = 0.007; P = 0.03). Higher rates of complicated appendicitis were observed in adults (adults: OR 2.00, P < 0.0001; children: OR 1.64, P = 0.12). Time to first consultation did not change significantly (adults: 52.3 vs. 38.5 h – P = 0.057; children: 51.5 vs. 32.0 h – P = 0.062) and length of stay was also not lengthened during the pandemic (adults: 2.9 vs. 2.7 days, P = 0.057; children: 4.2 vs. 3.7 days, P = 0.062). Conclusion The COVID-19 pandemic of 2020 had major impact on incidence and treatment strategies of acute appendicitis. Results of this meta-analysis might be another hint to support the theory that appendicitis is not a progressive disease and surgeons can safely consider antibiotic therapy for acute uncomplicated appendicitis.

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Section: Resultsmentioning

confidence: 99%

Changes in appendicitis treatment during the COVID-19 pandemic – A systematic review and meta-analysis

Köhler

Müller

Hendricks

et al. 2021

International Journal of Surgery

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“…It could be surely argued that the suggestion to "stay at home as much as possible" to save precious resources for more severe Covid patients might have caused the presentation of patients in more advanced stages of the disease. This may possibly be the case with acute cholecystitis and acute appendicitis [8] and more generally with peritonitis [9]. Our study did not consider the degree of severity of each of the analysed conditions, but if we take the therapeutic approach as an indirect index of severity, we could state that in our experience there was no difference in severity of the presentations between the pre-Covid and the Covid eras (Table 5).…”

Section: Discussionmentioning

confidence: 86%

Emergency Surgery Admissions and The COVID-19 Pandemic: Did The First Wave Really Change Our Practice? Results of An ACOI/WSES International Audit On 6263 Patients.

Tebala

Milani²,

Bignell

et al. 2021

Preprint

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IntroductionThe COVID-19 pandemic is having a deep impact on emergency surgical services, with a significant reduction of patients admitted into emergency surgical units world widely. Reliable figures of this reduction have not been produced yet. Our international audit aimed at giving a precise snapshot of the absolute and relative changes of emergency surgical admissions at the outbreak of the pandemic. Materials and methodsDatasets of patients admitted as general surgical emergencies into 45 internationally distributed emergency surgical units during the months of March and April 2020 (Covid-19 pandemic outbreak) were collected and compared with those of patients admitted into the same units during the months of March and April 2019 (pre-Covid-19). Primary endpoint was to evaluate the relative variation of the presentation symptoms and discharge diagnoses between the two study periods. Secondary endpoint was to identify the possible change of therapeutic strategy during the same two periods. ResultsForty-four centres participated sent their anonymised data to the study hub, for a total of 6263 patients. Of these, 3810 were admitted in the pre-Covid period and 2453 in the Covid period, for a 35.6% absolute reduction. The most common presentation was abdominal pain, whose incidence did not change between the two periods, but in the Covid period patients presented less frequently with anal pain, hernias, anaemia and weight loss. ASA 1 and low frailty patients were admitted less frequently, while ASA>1 and frail patients showed a relative increase. The type of surgical access did not change significantly, but lap-to-open conversion rate halved between the two study periods. Discharge diagnoses of appendicitis and diverticulitis reduced significantly, while bowel ischaemia and perianal ailments had a significant relative increase.ConclusionsOur audit demonstrates a significant overall reduction of emergency surgery admissions at the outbreak of the Covid-19 pandemic with a minimal change of the proportions of single presentations, diagnoses and treatments. These findings may open the door to new ways of managing surgical emergencies without engulfing the already busy hospitals.

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“…This mortality was higher in patients with symptoms (23.1%) compared to those without symptoms (5.6%), although not statistically signi cant. Fallani et al [19], reported a higher rate of postoperative complications during the COVID-19 pandemic in patients with peritonitis. They found that the ASA score, severity of peritonitis, qSOFA score, diagnosis other than appendicitis, and COVID period resulted independent predictors of complications.…”

Section: Discussionmentioning

confidence: 98%

Outcomes of COVID-19 patients that needed emergency general surgery: predictors of mortality and postoperative complications

Bozada‐Gutiérrez

Trejo-Ávila

Valenzuela-Salazar

et al. 2021

Preprint

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Purpose There is limited data about the perioperative outcomes of COVID−19 patients that needed emergency general surgery. The aims of the present study were to describe the perioperative outcomes of COVID−19 patients that underwent emergency general surgery and to determine possible predictors of mortality and postoperative complications. Methods A prospective study of positive COVID−19 patients that needed an emergency general surgery procedure at our center was performed. Results From March 2020 to February 2021, 44 patients were included. We found that patients with SARS-CoV−2 symptomatic disease have increased postoperative complications, higher ICU admissions, prolonged length of stay, and decreased 90-day survival as compared with asymptomatic COVID−19 patients. The 90-day survival probability of the entire cohort was 70.1% (60.3–79.9) and was significantly lower in patients with COVID−19 symptoms 63.4% (50.5–76.2). We found the following cut-off values for the prediction of mortality: ferritin ≥ 438.5 ng/mL (AUC = 0.908), CRP value ≥ 12.5 mg/dL (AUC = 0.715), leukocyte ≥ 13.8 x103/µL (AUC = 0.706), and albumin ≤ 2.78 g/dL (AUC = 704,). Also, a cut-off value of CRP of ≥ 12.5 mg/dL yielded an accuracy of 82.9% for the prediction of postoperative complications (p < 0.001). Conclusion Patients with symptomatic COVID−19 that needed emergency surgery have increased postoperative complications, higher ICU admissions, prolonged length of stay, and decreased 90-day survival as compared with asymptomatic COVID−19 patients. Preoperative ferritin, CRP, leukocytes, and albumin could be used as predictors of mortality.

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Urgent and emergency surgery for secondary peritonitis during the COVID-19 outbreak: an unseen burden of a healthcare crisis

Cited by 14 publications

References 25 publications

Changes in appendicitis treatment during the COVID-19 pandemic – A systematic review and meta-analysis

Changes in appendicitis treatment during the COVID-19 pandemic – A systematic review and meta-analysis

Emergency Surgery Admissions and The COVID-19 Pandemic: Did The First Wave Really Change Our Practice? Results of An ACOI/WSES International Audit On 6263 Patients.

Outcomes of COVID-19 patients that needed emergency general surgery: predictors of mortality and postoperative complications

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