Incidence of complicated appendicitis during the COVID-19 pandemic: A systematic review and meta-analysis

Kariya, Abduljubbar; Krutsri, Chonlada; Singhatas, Pongsasit; Sumritpradit, Preeda; Thampongsa, Tharin; Lertsitthichai, Panuwat; Phoprom, Napaphat

doi:10.1016/j.ijso.2022.100512

Cited by 16 publications

(15 citation statements)

References 20 publications

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“…They suggested that the reason for this delay is patient concern about COVID-19 transmission at the hospital. However, the finding that the time between symptom onset and emergency department visit remained unchanged in other studies was consistent with ours [ 20 21 22 ].…”

Section: Discussionsupporting

confidence: 92%

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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Section: Discussionsupporting

confidence: 92%

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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“…During the pandemic we identified a statistically significant increase in the rates of complicated appendicitis. A rise in the number of patients presenting with complicated appendicitis has also been demonstrated in other studies [ 33 , 34 ], with reported increased relative risk of 1.55 in a meta-analysis of 3559 patients [ 36 ]. We believe the significant increase in complicated appendicitis can account for the significant increase in rates of caecectomy and intraoperative insertion of drains.…”

Section: Discussionsupporting

confidence: 57%

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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“…A large number of studies and meta-analyses have reported an increase in the proportion of complicated appendicitis during the Covid-19 pandemic, suggesting increased delay as explanation [1][2][3][4][5][6][7]. Some studies also report a concomitant decrease in the number of uncomplicated appendicitis, suggesting that undiagnosed uncomplicated appendicitis may resolve without treatment due to the restrained access to health care [4].…”

Section: Introductionmentioning

confidence: 99%

“…As the proportion of complicated appendicitis is determined by the number of complicated appendicitis as numerator and the total number of patients with appendicitis as denominator, the concomitant decrease in the number of patients with uncomplicated appendicitis must also have had an impact [4]. It is known that variations in the incidence rate of uncomplicated appendicitis are more closely associated with the proportion of complicated appendicitis [8], whereas the impact of the Covid pandemic on the proportion of complicated appendicitis has been analyzed in several meta‐analyses we have not seen any previous analysis of the impact on the incidences of complicated and uncomplicated appendicitis separately [2–7].…”

Section: Introductionmentioning

confidence: 99%

Spontaneous Resolution of Uncomplicated Appendicitis may Explain Increase in Proportion of Complicated Appendicitis During Covid‐19 Pandemic: a Systematic Review and Meta‐analysis

2023

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Background Reports of an increased proportion of complicated appendicitis during the Covid-19 pandemic suggest a worse outcome due to delay secondary to the restrained access to health care, but may be explained by a concomitant decrease in uncomplicated appendicitis. We analyze the impact of the pandemic on the incidences of complicated and uncomplicated appendicitis. Method We did a systematic literature search in the PubMed, Embase and Web Of Science databases on December 21, 2022 with the search terms (appendicitis OR appendectomy) AND (“COVID” OR SARS-Cov2 OR “coronavirus”). Studies reporting the number of complicated and uncomplicated appendicitis during identical calendar periods in 2020 and the pre-pandemic year(s) were included. Reports with indications suggesting a change in how the patients were diagnosed and managed between the two periods were excluded. No protocol was prepared in advance. We did random effects meta-analysis of the change in proportion of complicated appendicitis, expressed as the risk ratio (RR), and of the change in number of patients with complicated and uncomplicated appendicitis during the pandemic compared with pre-pandemic periods, expressed as the incidence ratio (IR). We did separate analyses for studies based on single- and multi-center and regional data, age-categories and prehospital delay. Results The meta-analysis of 100,059 patients in 63 reports from 25 countries shows an increase in the proportion of complicated appendicitis during the pandemic period (RR 1.39, 95% confidence interval (95% CI 1.25, 1.53). This was mainly explained by a decreased incidence of uncomplicated appendicitis (incidence ratio (IR) 0.66, 95% CI 0.59, 0.73). No increase in complicated appendicitis was seen in multi-center and regional reports combined (IR 0.98, 95% CI 0.90, 1.07). Conclusion The increased proportion of complicated appendicitis during Covid-19 is explained by a decrease in the incidence of uncomplicated appendicitis, whereas the incidence of complicated appendicitis remained stable. This result is more evident in the multi-center and regional based reports. This suggests an increase in spontaneously resolving appendicitis due to the restrained access to health care. This has important principal implications for the management of patients with suspected appendicitis.

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Incidence of complicated appendicitis during the COVID-19 pandemic: A systematic review and meta-analysis

Cited by 16 publications

References 20 publications

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

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

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

Spontaneous Resolution of Uncomplicated Appendicitis may Explain Increase in Proportion of Complicated Appendicitis During Covid‐19 Pandemic: a Systematic Review and Meta‐analysis

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