Decision-making changes for patients and medical personnel in the management of acute appendicitis during the COVID-19 pandemic

Abstract

Background Acute appendicitis is the most common cause of acute abdomen. During the pandemic, to contain the spread of COVID-19, there were some integral changes in the medical processes based on the pandemic prevention policy, especially regarding emergency surgery. This study was conducted to investigate whether this pandemic also impacted the decision-making for both patients and medical personnel along with the treatment outcomes. Methods Patients of age 18 years or older who were diagnosed clinically and radiologically with acute appendicitis between Jan 1, 2017, and Dec 31, 202,0 were reviewed. The data of 1991 cases were collected and used for this study. Two groups were formed, one group before and the other group after the outbreak. The gathered data included gender, age, appendiceal fecalith, outcomes of treatment, and long-term outcomes of non-operation (8 months follow-up). We also collected details of surgical cases from the above two groups. This data also included age, gender, appendiceal fecalith, fever, jaundice, length of onset before presenting to an emergency department (ED), anesthesia, surgery, white cell count, pathology, complications, and length of stay. We compared the above data respectively and analyzed the differences. Results Compared to the period before the outbreak, patient visits for acute appendicitis remarkably dropped (19.8%), but surgical cases showed no change (dropped by roughly 5%). There were significant differences (P < 0.05) in failure of non-operation(after the pandemic 8.31% vs. before pandemic 3.22%), interval appendectomy(after pandemic 6.29% vs. before pandemic 12.84%), recurrence(after pandemic 23.27% vs. before pandemic 14.46%), and outcomes of recurrence. There was a significant difference (P < 0.05) in anesthesia method, surgery way, and complications( before pandemic 4.15% vs. after pandemic9.89% P < 0.05) in patients who underwent the surgery. There was no statistical difference (P > 0.05) concerning age, gender, fever, jaundice, appendiceal fecalith, white cell count, and length of onset before presenting to the ED. Conclusion The current pandemic prevention policy is very effective, but some decision-making processes of doctor-patient have changed in the context of COVID-19 pandemic, that further influenced some treatment outcomes and might lead to a potential economic burden. It is essential to address the undue concern of everyone and optimize the treatment process.

Acute care pathway assessed through performance indicators during the COVID-19 pandemic in OECD countries (2020-2021): a scoping review

“…Previous studies have investigated the impact of the COVID-19 pandemic in the acute care setting on speci c countries (23,203,199,201), phases of the pathway (136, 201), or diseases (197,202,204). This scoping review provides a comprehensive overview of the changes reported on the quality of acute care during the rst year and a half of the COVID-19 pandemic, covering OECD countries, multiple diseases, and following a care pathway approach.…”

Three-Year Outcomes of Oral Antibiotics vs Intravenous and Oral Antibiotics for Uncomplicated Acute Appendicitis

“…Current evidence shows that antibiotic treatment for uncomplicated acute appendicitis is safe and efficient and results in major cost savings compared with surgery . The advantages of treating appendicitis without surgery and minimizing the associated length of hospitalization were further emphasized during the COVID-19 pandemic . These findings have had a major impact on the treatment strategies for acute appendicitis, making antibiotics a widely recognized feasible first-line treatment option .…”

“…[4][5][6][7] The advantages of treating appendicitis without surgery and minimizing the associated length of hospitalization were further emphasized during the COVID-19 pandemic. [8][9][10] These findings have had a major impact on the treatment strategies for acute appendicitis, 9,10 making antibiotics a widely recognized feasible first-line treatment option. 5 Furthermore, studies suggest that outpatient management of uncomplicated acute appendicitis could be a feasible option, leading to substantial cost savings and better allocation of hospital resources.…”