Increase in Pediatric Perforated Appendicitis in the New York City Metropolitan Region at the Epicenter of the COVID-19 Outbreak

Abstract

Objective: The aim of the study was to determine whether perforated appendicitis rates in children were influenced by the Coronavirus disease 2019 (COVID-19) surge. Background: Disruption of care pathways during a public health crisis may prevent children from obtaining prompt assessment for surgical conditions. Progression of appendicitis to perforation is influenced by timeliness of presentation. In the context of state-mandated controls and public wariness of hospitals, we investigated the impact of the COVID-19 outbreak on perforated appendicitis in children. Study Design: We conducted an analysis of all children presenting to 3 hospital sites with acute appendicitis between March 1 and May 7, 2020, corresponding with the peak COVID-19 outbreak in the New York City region. Control variables were collected from the same institutions for the preceding 5 years. The primary outcome measure was appendiceal perforation. Results: Fifty-five children presented with acute appendicitis over 10 weeks. Compared to a 5-year control cohort of 1291 patients, we observed a higher perforation rate (45% vs 27%, odds ratio 2.23, 95% confidence interval 1.29–3.85, P = 0.005) and longer mean duration of symptoms in children with perforations (71 ± 39 vs 47 ± 27 h, P = 0.001) during the COVID-19 period. There were no differences in perforation rates (55% vs 59%, P = 0.99) or median length of stay (1.0 vs 3.0 days, P = 0.58) among children screening positive or negative for SARS-CoV-2. Conclusions: Children in the epicenter of the COVID-19 outbreak demonstrated higher rates of perforated appendicitis compared to historical controls. Preoperative detection of SARS-CoV-2 was not associated with inferior outcomes. Although children likely avoid much of the morbidity directly linked to COVID-19, disruption to local healthcare delivery systems may negatively impact other aspects of pediatric surgical disease.

Timely care for extrauterine pregnancies during the COVID-19 pandemic is needed

“…The most likely reason for the findings by Anteby and colleagues is a delay in arrival at the emergency department [2] . This corresponds to studies reporting significant increase in perforated and gangrenous appendicitis due to delay in seeking care during the COVID-19 pandemic [ 3 , 4 ].…”

Acute complex appendicitis during the COVID-19 epidemic: A single-institution retrospective analysis based on real-world data

“…It has been reported that due to the impact of the epidemic, patients have reduced their visits to hospitals for fear of increased risks of COVID-19 infection. [ 7 ] The number of visits to the department of emergencysurgery decreased, [ 16 ] as well as the number of patients in other disciplines, including the postponing of urinary surgical procedures, [ 17 ] decreased outpatient hemodialysis, [ 18 ] interruption of organ transplantation, [ 19 ] and so on. The incidence of acute appendicitis has also decreased, which is consistent with our findings.…”

“…[ 5 ] Most patients can achieve good therapeutic effect by timely appendectomy, [ 6 ] but the public health crisis caused by COVID-19 is a barrier to timely surgical treatment. Such as, during the COVID-19 outbreak, many patients described a delay in seeking assessment for their symptoms due to fears of in-hospital COVID-19 infection; [ 7 ] some COVID-19 patients also shown gastrointestinal symptoms, [ 8 ] which might interfere with doctors' timely and accurate diagnosis; hospitals would adopt more stringent epidemic prevention measures, [ 9 ] which also increased the time of each link from admission to discharge.…”

Favorable postoperative outcomes for children with COVID-19 infection undergoing surgical intervention: Experience at a free-standing children's hospital

“… [32] , [33] , [34] , [35] Several authors have described performing nonoperative management of appendicitis during the current pandemic. [ 36 , 37 ] Kvasnovsky et al reported over half of all appendicitis cases failed initial nonoperative management, which was defined as persistence of pain, fever, or emesis after 12 – 24 hours. [36] Of the 30 patients undergoing surgical intervention, over half were diagnosed with uncomplicated appendicitis.…”