Impact of COVID-19 on presentation, management, and outcomes of acute care surgery for gallbladder disease and acute appendicitis

Abstract

BACKGROUND The ongoing coronavirus disease 2019 (COVID-19) pandemic has significantly disrupted both elective and acute medical care. Data from the early months suggest that acute care patient populations deferred presenting to the emergency department (ED), portending more severe disease at the time of presentation. Additionally, care for this patient population trended towards initial non-operative management. AIM To examine the presentation, management, and outcomes of patients who developed gallbladder disease or appendicitis during the pandemic. METHODS A retrospective chart review of patients diagnosed with acute cholecystitis, symptomatic cholelithiasis, or appendicitis in two EDs affiliated with a single tertiary academic medical center in Northern California between March and June, 2020 and in the same months of 2019. Patients were selected through a research repository using international classification of diseases (ICD)-9 and ICD-10 codes. Across both years, 313 patients were identified with either type of gallbladder disease, while 361 patients were identified with acute appendicitis. The primary outcome was overall incidence of disease. Secondary outcomes included presentation, management, complications, and 30-d re-presentation rates. Relationships between different variables were explored using Pearson’s r correlation coefficient. Variables were compared using the Welch’s t-Test, Chi-squared tests, and Fisher’s exact test as appropriate. RESULTS Patients with gallbladder disease and appendicitis both had more severe presentations in 2020. With respect to gallbladder disease, more patients in the COVID-19 cohort presented with acute cholecystitis compared to the control cohort [50% (80) vs 35% (53); P = 0.01]. Patients also presented with more severe cholecystitis in 2020 as indicated by higher mean Tokyo Criteria Scores [mean (SD) 1.39 (0.56) vs 1.16 (0.44); P = 0.02]. With respect to appendicitis, more patients were diagnosed with a perforated appendix at presentation in 2020 [20% (36) vs 16% (29); P = 0.02] and a greater percentage were classified as emergent cases using the emergency severity index [63% (112) vs 13% (23); P < 0.001]. While a greater percentage of patients were admitted to the hospital for gallbladder disease in 2020 [65% (104) vs 50% (76); P = 0.02], no significant differences were observed in hospital admissions for patients with appendicitis. No significant differences were observed in length of hospital stay or operative rate for either group. However, for patients with appendicitis, 30-d re-presentation rates were significantly higher in 2020 [13% (23) vs 4% (8); P ...

Characteristics of Acute Appendicitis before and during the COVID-19 Pandemic: Single Center Experience

“…Furthermore, a significant increase in delayed medical treatment for various emergencies during the COVID-19 pandemic period has been noted [ 13 , 14 ]. Several recent studies of acute appendicitis during COVID-19 pandemic clearly show that staying at home due to public health safety orders negatively impacted children and adults who developed appendicitis [ 6 , 10 , 13 – 15 ]. During the COVID-19 pandemic, an increased rate of perforated appendicitis, compared to the pre-COVID-19 period, was reported in several published studies [ 6 , 10 , 14 , 16 – 18 ].…”

“…Several recent studies of acute appendicitis during COVID-19 pandemic clearly show that staying at home due to public health safety orders negatively impacted children and adults who developed appendicitis [ 6 , 10 , 13 – 15 ]. During the COVID-19 pandemic, an increased rate of perforated appendicitis, compared to the pre-COVID-19 period, was reported in several published studies [ 6 , 10 , 14 , 16 – 18 ]. Moreover, it has been noted that patients with perforated appendicitis have had an increased rate of complications and length of hospital stay [ 3 , 11 , 12 , 17 , 19 , 20 ].…”

“…Early diagnosis of appendicitis and consequent appropriate surgical treatment is important as it may prevent complications such as appendix perforation, abscess formation, and other postoperative complications including death [ 9 ]. During the COVID-19 pandemic, it is expected that more patients will seek out medical care in the later stage of the disease along with significant complications [ 2 , 10 ]. The aim of this study is to investigate the characteristics and management of patients with acute appendicitis in our hospital during the first wave of COVID-19 pandemic compared to the pre-COVID-19 period.…”

COVID-19 and Acute Cholecystitis Management: A Systematic Review of Current Literature

“…A total of 1,333 patients were studied before and 1,235 after the onset of the pandemic. Four studies reported numbers in all three different approaches regarding acute cholecystitis management and are therefore examined together ( 13 , 15 , 16 , 23 ). Combining the results of these studies, 344 patients were examined before and 497 during the COVID-19 period.…”

“…Surgical management was reported in 215 patients (62.5%) before and 275 (55.3%) during the pandemic. One study showed a relative increase in the number of PCs performed during the COVID-19 period ( 23 ). These results indicate that throughout the pandemic, there has been a slide tendency toward conservative management, whereas the surgical approach is less considered compared to the pre-COVID-19 period.…”