We can reduce negative paediatric appendicectomy rate: A cohort study

Abstract

Background Appendicitis accounts for the most frequent surgical emergencies in childhood. The guidance from the Royal College of Surgeons and poor post operative outcomes in surgical patients during the pandemic, it would be expected that only children who had clinical signs of appendicitis and were unwell, would have undergone surgery. Hence, the negative appendicectomy rate during the pandemic should have decreased. The aim of this retrospective study was to assess the rate of negative appendicectomy amongst children <16 years of age during the first wave of the pandemic, from the announcement of the lockdown and determine if there was a true difference by comparing the rate with the same time period in 2019. Material and methods Data of all children aged<16 years who were operated for appendicitis between 23/3/2020 and 30/06/2020 was collected retrospectively and compared with that of children operated during the same time period in 2019 for the rate of negative appendicectomy. Data were analysed using the two-tailed t -test for continuous data and χ2 or Fishers exact tests for categorical data with p value of <0.05 considered significant. Results Twenty three paediatric patients presenting with acute appendicitis underwent appendicectomy during the COVID-19 pandemic and 35 patients during 2019. Overall 17.39% patients underwent laparoscopic appendicectomy in 2020 while 54.29% in 2019. The negative appendicectomy rate was zero during the pandemic while it was 17.14% in 2019. There was no difference in the median length of hospital stay during the two time periods. There was no significant difference in complication or re-admission rate. Conclusion This study has the lowest reported incidence of negative appendicectomy rate during the pandemic following wider use of pre operative imaging and early senior involvement in decision making. The increased number of complicated appendicitis during the pandemic did not translate to worse clinical outcomes.

Reasons for Delayed Diagnosis of Pediatric Acute Appendicitis during the COVID-19 Era: A Narrative Review

“…Comparable results were reported by Del Giorgio et al [50]. Some studies identified a significant increase in perforated case numbers during the pandemic despite similar durations of symptoms [25,26,45].…”

“…It is possible that during the pandemic, more effort was made to establish a correct diagnosis preoperatively. This could have been due to greater imaging use, more direct senior consultant involvement and a higher threshold for surgical exploration [43,45]. Cases that were diagnostically uncertain were more likely to be managed non-operatively during the pandemic, as recommended by guidelines [96,97].…”

Management and outcomes of acute appendicitis in children during the COVID-19 pandemic: a systematic review and meta-analysis

“…Of 528 title/abstract screened, 129 full-text articles were analyzed, 43 studies entered the qualitative analysis [ 1 – 11 , 13 , 14 , 22 – 51 ], and 36 papers were included in the meta-analysis [ 1 – 8 , 11 , 13 , 22 , 23 , 25 – 28 , 30 – 44 , 46 – 50 ] (32,704 pts, Fig. 2 ).…”

“…All the 36 studies included in the meta-analysis were retrospective observational studies [ 1 – 8 , 11 , 13 , 22 , 23 , 25 – 28 , 30 – 44 , 46 – 50 ]. None of the papers provided sample size calculations.…”

Negative Appendectomy Rates -Current Prospective- A Review

“…The use of imaging modalities like ultrasound and computerized tomography have improved the diagnostic accuracy and reduced the negative appendectomy rate [34]. The use of ultrasound to diagnose acute appendicitis is useful as it involves any use of radiation, and it can be done in the emergency department.…”