Influence of Covid -19 on the management of Appendicitis

Abstract

Objective: Acute Appendicitis encounters as the frequent problem in surgical pediatric patients leading to Appendectomy, being one of the most common procedures performed in surgical Emergency. During COVID-19 pandemic, the trends in the management of acute appendicitis have changed. Conservative management of appendicitis with antibiotics is being proposed as an alternative to conventional appendectomy. So, this study is conducted to compare the presentation and outcome of Appendicitis managed during pre and post pandemic period in our settings. Methodology: After approval of Ethical Review Committee, a total of 267 patients of age 1-12 years were selected for the study. It was a retrospective Cohort Study. Patients were divided into group A (n=145) which was pre pandemic group. Data was collected retrospectively from charts regarding demographics, presentation, duration of stay operative findings and complications from May-Oct 2019 and Group B (n=122) during covid-19 was collected from the patients presented with appendicitis over a period of six months from May-Oct 2020 . Similar months of the year were selected to remove seasonal variation in the presentation of Appendicitis. All information was collected on a predesigned Performa. Data was compared and analyzed on SPSS 20. Results: Out of 267 patients, 151 (56.56%) were male. Group A patients presented during pre-pandemic period (n=145) were undergone appendectomy for appendicitis in 129 patients (88.96%) with 59 patients (40.68%) having acutely inflamed appendix and 70 patients (48.27%) had complicated appendicitis such as gangrenous, perforated with generalized peritonitis. In Group A only 16 patients (11.03%) were managed conservatively for appendicular mass. In contrast to group B (n=122) presented during pandemic, only 43 patients (35.24%) were operated with findings of acutely inflamed appendicitis while gangrenous/perforated appendicitis with pelvic abscess and/or generalized peritonitis was found in most of the patients with a number of 69 (56.55%), only 10 (8.19%) patient presented as Appendicular mass hence managed conservatively. Conclusion: Delay in presentation and early conservative management during pandemic crisis has resulted in an increase in the complications of Appendicitis. Early referral to specialized centers with vigilant selection for conservative treatment can save patients from developing complications. Keywords: Appendicitis, covid-19, Appendectomy, complications, Pandemic

Moving to Medical Treatment for COVID-19 Influence on Pediatric Appendicitis: A Meta-Analysis

“…Similar findings are also echoed by Zahra et al [ 2 ]. Study findings indicate a decrease in the number of patients treated for appendicitis during the pandemic period as opposed to the pre-pandemic period.…”

“…Although the pediatric population was less affected by COVID-19 as compared to the adult population, the pandemic has significantly altered AA surgical protocols and management guidelines [ 2 ]. Percul et al [ 3 ] also confirm that during the pandemic period, the number of visits to the emergency department due to AA significantly reduced, majorly due to reassessed management strategies.…”

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

“…Reasons for not including a report were: unclear definition of complicated and uncomplicated appendicitis [11,12], indications suggesting change in referral area during the pandemic [13,14], and inconsistent or incomplete data [15,16]. Studies reporting similar number of patients treated non-operatively with antibiotics in the two periods were included but studies that only reported results from non-operative management or with strong increase in use of non-operative management for assumed uncomplicated appendicitis during the pandemic period were excluded [17][18][19][20].…”