Management of appendicitis during COVID-19 pandemic; short-term outcomes

Radhakrishnan, Ganesh; Lucocq, James; Ekpete, Neville; Ain, Noor Ul; Lim, Su Kwan; Alwash, Al; Bibi, Saira; Alijani, Afshin

doi:10.1177/0036933020956316

Cited by 44 publications

(58 citation statements)

References 19 publications

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“…Another study by Patel et al 16 found no significant difference in complication rates of NOM in the setting of COVID-19 (1/24) and before COVID-19 (1/6) (p = 0.36). The adoption of NOM as a main treatment strategy during the pandemic did not increase readmission rates significantly as reported by Ganesh et al 13 (9.4% vs 12.5%, p = 0.75) nor increased the length of hospital stay. 13,16 Outcome of NOM in COVID-19 Positive Patients Two studies 15,22 reported on the outcomes of NOM in patients with COVID-19.…”

Section: Comparing Outcomes Of Nom Of Acute Appendicitis Before and Asupporting

confidence: 63%

“…The adoption of NOM as a main treatment strategy during the pandemic did not increase readmission rates significantly as reported by Ganesh et al 13 (9.4% vs 12.5%, p = 0.75) nor increased the length of hospital stay. 13,16 Outcome of NOM in COVID-19 Positive Patients Two studies 15,22 reported on the outcomes of NOM in patients with COVID-19. Overall, seven patients with COVID-19 were treated initially with NOM, with a failure rate of 43% at discharge.…”

Section: Comparing Outcomes Of Nom Of Acute Appendicitis Before and Asupporting

confidence: 63%

“…30 This discrepancy may be attributed to the delayed presentation of patients and inclusion of complicated appendicitis in the studies that reported on NOM efficacy in children during the pandemic. 15,21 Individual studies 13,16,17 compared the outcome of NOM during and before COVID-19 and no significant difference in the failure, complication, and 30-day readmission rates was found. Although these were single-center experiences, they may have an implication that the adoption of NOM as a main treatment strategy of acute appendicitis during the pandemic was not associated with a compromise of the short-term efficacy of NOM.…”

Section: Discussionmentioning

confidence: 99%

“…This systematic review included 14 studies [11][12][13][14][15][16][17][18][19][20][21][22][23][24] published in 2020. Five studies were based in the UK, three in USA, two in China, and one in Ireland, Nepal, Israel, and India.…”

Section: Study and Patients' Characteristicsmentioning

confidence: 99%

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Rate of Application and Outcome of Non-operative Management of Acute Appendicitis in the Setting of COVID-19: Systematic Review and Meta-analysis

Emile

Hamid²,

Khan

et al. 2021

Journal of Gastrointestinal Surgery

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Background Non-operative management (NOM) of acute appendicitis has been assessed in several studies before COVID-19 pandemic. This systematic review aimed to assess the extent of adoption, efficacy, and safety of NOM of acute appendicitis in the setting of COVID-19. Methods This was a PRISMA-compliant systematic review of the literature. Electronic databases and Google Scholar were queried for studies that applied NOM of acute appendicitis during COVID-19. The main outcome measures were the rates of NOM application during the pandemic as compared to the pre-pandemic period, failure and complication rates of NOM. Failure was defined as the need for appendectomy during NOM and complications included development of appendicular mass or abscess. Results Fourteen studies (2140 patients) were included. The male to female ratio was 1.44:1 and median age was 34. Nine hundred fifty-nine (44.8%) patients had a trial of NOM. The weighted mean rate of NOM application was 50.1% (95%CI: 29.8–70.5%). The application of NOM during the pandemic was significantly more likely than its application before COVID-19 (OR = 6.7, p < 0.001). The weight mean failure rate of NOM was 16.4% (95%CI: 9.4–23.4). NOM failure was more likely in children and patients with complicated appendicitis. The weighted mean complication rate after NOM was 4.5% (95%CI: 1.4–7.7). NOM had significantly lower odds for complications than appendectomy (OR = 0.36, p = 0.03). There was no mortality after application of NOM. Conclusion NOM of acute appendicitis in the setting of COVID-19 may be a safe, short-term alternative to surgery with acceptably low failure and complication rates. Supplementary Information The online version contains supplementary material available at 10.1007/s11605-021-04988-1.

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Section: Comparing Outcomes Of Nom Of Acute Appendicitis Before and Asupporting

confidence: 63%

Section: Comparing Outcomes Of Nom Of Acute Appendicitis Before and Asupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Study and Patients' Characteristicsmentioning

confidence: 99%

See 2 more Smart Citations

Rate of Application and Outcome of Non-operative Management of Acute Appendicitis in the Setting of COVID-19: Systematic Review and Meta-analysis

Emile

Hamid²,

Khan

et al. 2021

Journal of Gastrointestinal Surgery

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“…Second, in areas of diminished operative capacities due to high numbers of COVID-19 patients a conservative approach to appendicitis in situations of overwhelming strain on the health system has been advocated (30)(31)(32). Nevertheless, data from NYC metropolitan region showed that even in regions with crushing hospital burden it was still possible to commit to surgical care of pediatric patients during the COVID-19 surge (8).…”

Section: Discussionmentioning

confidence: 99%

Increased Incidence of Perforated Appendicitis in Children During COVID-19 Pandemic in a Bavarian Multi-Center Study

et al. 2021

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Introduction: Since early 2020 the COVID-19 pandemic and statutory preventive reorganization of treatment capacities with cancellation of elective surgery as well as curfew regulations led to vastly decreased utilization of primary health care.Materials and Methods: To assess whether there are negative effects on pediatric acute care in Bavaria during the spring 2020 lockdown a state-wide retrospective multi-center study was performed to analyze the rate of perforated appendicitis during lockdown. Children who have been operated on during the corresponding period in 2018/19 served as control group.Results: Overall, 514 patients (292 boys, 222 girls) were included (2020: 176 patients; 2019: 181 patients; 2018: 157 patients). Median age was 11.2 years. Four hundred thirty-nine patients (85.4%) underwent laparoscopic surgery, 69 (13.4%) open surgery and 1.2% underwent conversion from laparoscopic to open surgery. In 2020 a perforation rate of 27.8% (49/176 patients) was found, in 2018–2019 perforation rate was 20.7% (70/338 patients, p = 0.0359, Cochran-Mantel-Haenszel-Test). Subgroup analysis showed that in younger patients (≤ 11.2 years), in 2020 perforation rate was significantly higher with 37.6% (32/85 patients), while 22.2% (39/176) in 2018/2019 (p = 0.014, Fisher's exact test).In boys perforation rate was significantly higher in 2020 with 35.0% (35/100 patients) compared to 21.4% in 2018–2019 (p = 0.0165, Fisher's exact test).Conclusion: During the period of curfew regulations in Bavaria the rate of perforated appendicitis in childhood increased significantly, especially in younger children and boys. Potentially this has to be attributed to delayed presentation to pediatric surgery care. Because of potential long-term sequelae of perforated appendicitis these adverse effects during curfew have to be taken into account for future political decision making to ensure reasonable patient care and avoid collateral damage in near-future or on-going pandemic situations.

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Presentation and outcomes of acute appendicitis during COVID-19 pandemic: lessons learned from the Middle East—a multicentre prospective cohort study

Nakeeb

Emile

AbdelMawla

et al. 2022

Int J Colorectal Dis

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Background The coronavirus disease 2019 (COVID-19) pandemic had a striking impact on healthcare services in the world. The present study aimed to investigate the impact of the COVID-19 pandemic on the presentation management and outcomes of acute appendicitis (AA) in different centers in the Middle East. Methods This multicenter cohort study compared the presentation and outcomes of patients with AA who presented during the COVID-19 pandemic in comparison to patients who presented before the onset of the pandemic. Demographic data, clinical presentation, management strategy, and outcomes were prospectively collected and compared. Results Seven hundred seventy-one patients presented with AA during the COVID pandemic versus 1174 in the pre-COVID period. Delayed and complex presentation of AA was significantly more observed during the pandemic period. Seventy-six percent of patients underwent CT scanning to confirm the diagnosis of AA during the pandemic period, compared to 62.7% in the pre-COVID period. Non-operative management (NOM) was more frequently employed in the pandemic period. Postoperative complications were higher amid the pandemic as compared to before its onset. Reoperation and readmission rates were significantly higher in the COVID period, whereas the negative appendicectomy rate was significantly lower in the pandemic period (p = 0.0001). Conclusion During the COVID-19 pandemic, a remarkable decrease in the number of patients with AA was seen along with a higher incidence of complex AA, greater use of CT scanning, and more application of NOM. The rates of postoperative complications, reoperation, and readmission were significantly higher during the COVID period.

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Management of appendicitis during COVID-19 pandemic; short-term outcomes

Cited by 44 publications

References 19 publications

Rate of Application and Outcome of Non-operative Management of Acute Appendicitis in the Setting of COVID-19: Systematic Review and Meta-analysis

Rate of Application and Outcome of Non-operative Management of Acute Appendicitis in the Setting of COVID-19: Systematic Review and Meta-analysis

Increased Incidence of Perforated Appendicitis in Children During COVID-19 Pandemic in a Bavarian Multi-Center Study

Presentation and outcomes of acute appendicitis during COVID-19 pandemic: lessons learned from the Middle East—a multicentre prospective cohort study

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