Impact of Covid-19 Pandemic on pediatric appendicitis hospital admission time and length of hospital stay

Abstract

BACKGROUND: Appendicitis is one of the most common surgical emergencies among children. In this retrospective clinical study, we attempted to determine the effects of the COVID-19 pandemic period on hospital admission time and length of hospital stay (LOS) in pediatric appendicitis cases. METHODS:We retrospectively compared pediatric appendectomies from the date of the first reported COVID-19 case to June 1, 2020, which is considered as the start of the normalization process, with pre-pandemic pediatric appendectomies of the same number of days in terms of age, gender, hospital admission time, LOS, parental educational level, laboratory values, and histopathological findings. RESULTS:There was an average increase of 2 days in the time from the onset of symptoms to hospital admission in pediatric appendicitis patients in the COVID-19 period (p=0.001). Furthermore, C-reactive protein value was statistically significantly higher in the COVID-19 period (p=0.018). Given the LOS, it was calculated as an average of 5 days in the pre-pandemic period and 4 days in the COVID-19 period, and this difference was statistically insignificant (p=0.273). There was no significant difference between the groups in terms of histopathological findings (p=0.176). The parental educational level had no effect on the admission time. CONCLUSION:The hospital admission time of pediatric appendicitis patients is significantly prolonged in the COVID-19 pandemic, but this prolongation had no histopathological effect. During the pandemic, the recovery of patients who required urgent treatment during the "stay-at-home" period was also negatively affected. Notwithstanding, we are of the opinion that the absence of an increase in the LOS may be due to the willingness of both families and physicians to keep the LOS as short as possible. Despite the increase in hospital admission time in pediatric appendicitis during the Covid 19 pandemic process, the lack of increase in the rate of complicated appendicitis may be an indicator of the importance of other factors in the development of complicated appendicitis.

A critical appraisal on the treatment of acute appendicitis in pediatric population during the COVID-19 pandemic

“…Taşçi et al . 19 found that the interval between the onset of symptoms and hospital admission in pediatric patients with appendicitis increased by 2 days during the COVID-19 pandemic, which is consistent with another retrospective study that revealed a significantly longer time between symptom onset and presentation to the emergency department during the peak of the pandemic, with a few patients waited up to 14 days before seeking medical attention 17 .…”

Reasons for Delayed Diagnosis of Pediatric Acute Appendicitis during the COVID-19 Era: A Narrative Review

“…The authors concluded that delayed hospital admission did not alter outcomes. Another interesting observation was that parental education did not contribute to increased time before hospital admission [28]. Sheath et al found a similar 2-day delay to presentation with more complicated appendicitis cases [16].…”

“…Pediatric appendicitis outcomes can also be affected by lower socio-economic status as a consequence of hindered access to healthcare. This was studied before the pandemic [28,[57][58][59][60]. The associations between pediatric appendicitis outcomes and lower socio-economic status groups and poor nations that were highly affected by the pandemic warrant further study as there is no relevant evidence to date.…”

“…Parental anxiety and the psychosocial impact of COVID-19 on society as a whole, termed Coronaphobia, have been analyzed further by Dubey et al [66]. Level of family education level did not correlate with delayed visits to hospitals [28,66].…”