Suspected appendicitis and COVID-19, a change in investigation and management—a multicentre cohort study

English, William; Bedwani, N Habib; Smith, Christopher C.; Doganay, Emre; Marsden, M; Muse, Samantha; Mak, Wai Kin; Chana, Manik; Eves, Joshua; Shatkar, V

doi:10.1007/s00423-020-02023-6

Cited by 37 publications

(48 citation statements)

References 31 publications

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“…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%

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: Study and Patients' Characteristicsmentioning

confidence: 99%

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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“…[8] Overall, this German national "experiment" is in contrast to other countries such as the UK which was more severely affected during the crisis in spring 2020. For example, English et al reported a switch to nonoperative management in the majority of patients and laparoscopic procedures were omitted [9].…”

mentioning

confidence: 99%

Changes in the management of acute appendicitis during the COVID-19 pandemic

Lock

Wiegering

2021

Langenbecks Arch Surg

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“…During the first wave of the COVID-19 pandemic, patients undergoing surgery were more frequently affected by more severe appendicitis forms than the previous year's timeframe, according to both the AIR and the AAST scores. The present dataset is much more comprehensive than previous international and national surveys [ 8 , 21 , 22 ] and multicentre retrospective studies [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Appendectomy during the COVID-19 pandemic in Italy: a multicenter ambispective cohort study by the Italian Society of Endoscopic Surgery and new technologies (the CRAC study)

Sartori¹,

Podda

Botteri

et al. 2021

Updates Surg

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Major surgical societies advised using non-operative management of appendicitis and suggested against laparoscopy during the COVID-19 pandemic. The hypothesis is that a significant reduction in the number of emergent appendectomies was observed during the pandemic, restricted to complex cases. The study aimed to analyse emergent surgical appendectomies during pandemic on a national basis and compare it to the same period of the previous year. This is a multicentre, retrospective, observational study investigating the outcomes of patients undergoing emergent appendectomy in March–April 2019 vs March–April 2020. The primary outcome was the number of appendectomies performed, classified according to the American Association for the Surgery of Trauma (AAST) score. Secondary outcomes were the type of surgical technique employed (laparoscopic vs open) and the complication rates. One thousand five hundred forty one patients with acute appendicitis underwent surgery during the two study periods. 1337 (86.8%) patients met the inclusion criteria: 546 (40.8%) patients underwent surgery for acute appendicitis in 2020 and 791 (59.2%) in 2019. According to AAST, patients with complicated appendicitis operated in 2019 were 30.3% vs 39.9% in 2020 (p = 0.001). We observed an increase in the number of post-operative complications in 2020 (15.9%) compared to 2019 (9.6%) (p < 0.001). The following determinants increased the likelihood of complication occurrence: undergoing surgery during 2020 (+ 67%), the increase of a unit in the AAST score (+ 26%), surgery performed > 24 h after admission (+ 58%), open surgery (+ 112%) and conversion to open surgery (+ 166%). In Italian hospitals, in March and April 2020, the number of appendectomies has drastically dropped. During the first pandemic wave, patients undergoing surgery were more frequently affected by more severe appendicitis than the previous year's timeframe and experienced a higher number of complications. Trial registration number and date: Research Registry ID 5789, May 7th, 2020

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Suspected appendicitis and COVID-19, a change in investigation and management—a multicentre cohort study

Cited by 37 publications

References 31 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

Changes in the management of acute appendicitis during the COVID-19 pandemic

Appendectomy during the COVID-19 pandemic in Italy: a multicenter ambispective cohort study by the Italian Society of Endoscopic Surgery and new technologies (the CRAC study)

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