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Ali F, Sandblom G, Fathalla B, Wallin G. Effect of the SARS-CoV-2 pandemic on planned and emergency hernia repair in Sweden: a register-based study. Hernia 2023; 27:1103-1108. [PMID: 37418049 PMCID: PMC10533583 DOI: 10.1007/s10029-023-02828-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/18/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE The COVID-19 has had a profound impact on the health care delivery in Sweden, including deprioritization of benign surgeries during the COVID-19 pandemic. The aim of this study was to assess the effect of COVID-19 pandemic on emergency and planned hernia repair in Sweden. METHODS Data on hernia repairs from January 2016 to December 2021 were retrieved from the Swedish Patient Register using procedural codes. Two groups were formed: COVID-19 group (January 2020-December 2021) and control group (January 2016-December 2019). Demographic data on mean age, gender, and type of hernia were collected. RESULTS This study showed a weak negative correlation between the number of elective hernia repairs performed each month during the pandemic and the number of emergency repairs carried out during the following 3 months for inguinal hernia repair (p = 0.114) and incisional hernia repair (p = 0.193), whereas there was no correlation for femoral or umbilical hernia repairs. CONCLUSION The COVID-19 pandemic had a great impact on planned hernia surgeries in Sweden, but our hypothesis that postponing planned repairs would increase the risk of emergency events was not supported.
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Affiliation(s)
- Fathalla Ali
- Faculty of Medicine and Health, Department of Surgery, Örebro University, 70185, Örebro, Sweden.
- Department of Surgery, Karlskoga Hospital, 69144, Karlskoga, Sweden.
| | - Gabriel Sandblom
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden
| | - Blend Fathalla
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden
- Emergency Department, Södersjukhuset, Stockholm, Sweden
| | - Göran Wallin
- Faculty of Medicine and Health, Department of Surgery, Örebro University, 70185, Örebro, Sweden
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Iantorno SE, Skarda DE, Bucher BT. Concurrent SARS-COV-19 and acute appendicitis: Management and outcomes across United States children's hospitals. Surgery 2023; 173:936-943. [PMID: 36621446 PMCID: PMC9820025 DOI: 10.1016/j.surg.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/02/2022] [Accepted: 12/11/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Nonoperative management of acute appendicitis is a safe and effective alternative to appendectomy, though rates of treatment failure and disease recurrence are significant. The purpose of this study was to determine whether COVID-19-positive children with acute appendicitis were more likely to undergo nonoperative management when compared to COVID-19-negative peers and to compare clinical outcomes and healthcare use for these groups. METHODS A retrospective cohort study of children <18 years with acute appendicitis across 45 US Children's Hospitals during the first 12 months of the COVID-19 pandemic was performed. Operative management was defined as appendectomy or percutaneous drain placement, whereas nonoperative management was defined as admission with antibiotics alone. Multivariable hierarchical logistic regression using an exact matched cohort was used to determine the association between COVID-19 positivity and nonoperative management. The secondary outcomes included intensive care unit admission, mechanical ventilation, length of stay, nonoperative management failure rates, and hospital variation in nonoperative management. RESULTS Of 17,481 children in the cohort, 581 (3.3%) were positive for COVID-19. The odds of nonoperative management was significantly higher in the COVID-19-positive group (adjusted odds ratio [95% confidence interval]: 13.4 [10.7-16.8], P < .001). Patients positive for COVID-19 had increased odds of intensive care unit admission (adjusted odds ratio [95% confidence interval]: 3.78 [2.01-7.12], P < .001) and longer length of stay (median 2 days vs 1 day, P < .001). Hospital rates of nonoperative management ranged from 0% to 100% for COVID-19-positive patients and 0% to 42% for COVID-19-negative patients. CONCLUSION Children with concurrent acute appendicitis and COVID-19 positivity are significantly more likely to undergo nonoperative management. Both groups experience infrequent nonoperative management failure rates and rare intensive care unit admissions. Marked hospital variability in nonoperative management practices was demonstrated.
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Affiliation(s)
- Stephanie E Iantorno
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.
| | - David E Skarda
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Brian T Bucher
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
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Zarog M, O’Leary P, Kiernan M, Bolger J, Tibbitts P, Coffey S, Byrnes G, Peirce C, Dunne C, Coffey C. Circulating fibrocyte percentage and neutrophil-lymphocyte ratio are accurate biomarkers of uncomplicated and complicated appendicitis: a prospective cohort study. Int J Surg 2023; 109:343-351. [PMID: 37093074 PMCID: PMC10389644 DOI: 10.1097/js9.0000000000000234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/09/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND There is increasing evidence that uncomplicated appendicitis (UA) may be treated nonoperatively in cases of UA. This study aimed to evaluate and compare the diagnostic accuracy of circulating fibrocyte percentage (CFP), white blood cell count, C-reactive protein, and neutrophil-lymphocyte ratio (NLR) in diagnosing uncomplicated and complicated appendicitis. MATERIALS AND METHODS Eighty consecutive adult patients presenting with suspected appendicitis were recruited in a cohort-based prospective study between June 2015 and February 2016 at University Hospital Limerick in Ireland. Peripheral venous samples were obtained at the presentation. Clinical, biochemical, radiological, and histopathological parameters were recorded. The CFP was determined by dual-staining for CD45 and collagen-I using flow cytometry analysis and correlated with histopathological diagnoses. RESULTS Of the 46 patients who underwent appendicectomy, 34 (73.9%) had histologically proven acute appendicitis. A comparison of the diagnostic accuracy of biomarkers demonstrated the CFP had the highest diagnostic accuracy for UA (area under the curve=0.83, sensitivity=72.7%, specificity=83.3%, P=0.002). The NLR had the highest diagnostic accuracy in relation to complicated appendicitis (area under the curve=0.84, sensitivity=75.5%, specificity=83.3%, P=0.005). CONCLUSIONS CFP and NLR are accurate biomarkers of UA and complicated appendicitis.
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Lescinska AM, Sondore E, Ptasnuka M, Mukans M, Plaudis H. The Course and Surgical Treatment of Acute Appendicitis during the First and Second Wave of the COVID-19 Pandemic: A Retrospective Analysis in University Affiliated Hospital in Latvia. Medicina (Kaunas) 2023; 59:medicina59020295. [PMID: 36837497 PMCID: PMC9966030 DOI: 10.3390/medicina59020295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/27/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023]
Abstract
Background and Objectives: Acute appendicitis is the most common abdominal emergency requiring surgery and it has an estimated lifetime risk of 6.7 to 8.6%. The COVID-19 pandemic has transformed medical care worldwide, influencing diagnostic tactics, treatment modalities and outcomes. Our study aims to compare and analyze management of acute appendicitis before and during the first and second waves of the pandemic. Materials and Methods: Patients suffering acute appendicitis were enrolled retrospectively in a single-center study for a 10-month period before the pandemic (pre-COVID-19 period: 1 March to 31 December 2019) and during the pandemic (COVID-19 period: 1 March to 31 December 2020). The total number of patients, disease severity, diagnostic methods, complications, length of hospitalization and outcomes were analyzed. Results: A total number of 863 patients were included, 454 patients in the pre-COVID-19 period and 409 patients in the COVID-19 period. Compared to the pre-COVID-19 period, the number of complicated appendicitis increased in the COVID-19 period (24.4% to 37.2%; p < 0.001). The proportion of laparoscopic appendectomies increased during the COVID-19 period but did not show statistically significant differences between periods. In both time periods, we found that open technique was the chosen surgical approach more frequently in elderly patients (p < 0.001). Generalized peritonitis was significantly more common during the COVID-19 period (3.5% vs. 6.1%, p < 0.001). The postoperative course of patients was similar in the pre-COVID-19 period and during the COVID-19 period, with no significant differences in ICU admissions, overall hospital stay or morbidity. Conclusions: The COVID-19 pandemic has led to a significant increase in complicated forms of acute appendicitis; however, no significant impact was observed in terms of diagnostic or treatment approach.
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Affiliation(s)
- Anna Marija Lescinska
- Faculty of Medicine, University of Latvia, LV-1004 Riga, Latvia
- Faculty of Medicine, Riga Stradins University, LV-1007 Riga, Latvia
- Department of General and Emergency Surgery, Riga East Clinical University Hospital, LV-1038 Riga, Latvia
- Correspondence: ; Tel.: +371-29258517
| | - Elza Sondore
- Faculty of Medicine, Riga Stradins University, LV-1007 Riga, Latvia
- Department of General and Emergency Surgery, Riga East Clinical University Hospital, LV-1038 Riga, Latvia
| | - Margarita Ptasnuka
- Faculty of Medicine, Riga Stradins University, LV-1007 Riga, Latvia
- Department of General and Emergency Surgery, Riga East Clinical University Hospital, LV-1038 Riga, Latvia
| | - Maksims Mukans
- Faculty of Medicine, Riga Stradins University, LV-1007 Riga, Latvia
| | - Haralds Plaudis
- Faculty of Medicine, Riga Stradins University, LV-1007 Riga, Latvia
- Department of General and Emergency Surgery, Riga East Clinical University Hospital, LV-1038 Riga, Latvia
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Achavanuntakul C, Mahawongkajit P, Orrapin S, Auksornchat K, Boonyasatid P, Waewsri N, Moriguchi A, Kanlerd A. The Impact of the COVID-19 Pandemic on the Incidence, Severity, and Management of Acute Appendicitis: A Single Center Experience in Thailand. Emerg Med Int 2022; 2022:8324716. [PMID: 36467864 PMCID: PMC9715343 DOI: 10.1155/2022/8324716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/08/2022] [Accepted: 11/12/2022] [Indexed: 10/03/2023] Open
Abstract
PURPOSE For more than two years since the COVID-19 pandemic, human lives have changed, including the healthcare system. Management of acute appendicitis, the most common emergency surgical disease, has been inevitably affected. This study aimed to assess the effect of the COVID-19 pandemic on the incident rate of complicated appendicitis, management, outcome, and complication of acute appendicitis. Patients and Methods. This study was a retrospective cohort study comparing 574 patients diagnosed with acute appendicitis before the COVID-19 outbreak and 434 patients diagnosed with acute appendicitis during the COVID-19 outbreak. Patient demographic data, type of appendicitis, type of treatment, time to surgery, length of stay, cost, and complications were collected and analyzed. RESULTS During the COVID-19 pandemic, the number of patients diagnosed with acute appendicitis was reduced. CT scan usage for diagnosis was increased compared to pre-COVID-19. Most patients diagnosed with acute appendicitis received operative treatment in both groups. Median time to surgery was significantly longer during the COVID-19 pandemic, 11.93 hours compared to 9.62 hours pre-COVID-19, p-value <0.001 (relative risk 1.5, 95% CI 1.29-1.76, p value 0.041). The incidence of complicated appendicitis was not higher during COVID-19. Compared to pre-COVID-19, ICU admission rate, the use of a mechanical ventilator, length of stay, and cost increased in the univariate analysis but were not statistically significant in the multivariate analyses. Other treatment complications had no statistically significant difference. CONCLUSION The incidence of complicated appendicitis did not increase during the COVID-19 pandemic. The operation waiting time significantly increased but did not increase the rate of treatment complications in a well-prepared hospital system.
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Affiliation(s)
- Chompoonut Achavanuntakul
- Department of Surgery, Faculty of Medicine, Thammasat University, Thammasat University Hospital, Pathumthani, Thailand
| | - Prasit Mahawongkajit
- Department of Surgery, Faculty of Medicine, Thammasat University, Thammasat University Hospital, Pathumthani, Thailand
| | - Saritphat Orrapin
- Department of Surgery, Faculty of Medicine, Thammasat University, Thammasat University Hospital, Pathumthani, Thailand
| | - Karikarn Auksornchat
- Department of Surgery, Faculty of Medicine, Thammasat University, Thammasat University Hospital, Pathumthani, Thailand
| | - Piyapong Boonyasatid
- Department of Surgery, Faculty of Medicine, Thammasat University, Thammasat University Hospital, Pathumthani, Thailand
| | - Nichakarn Waewsri
- Department of Surgery, Faculty of Medicine, Thammasat University, Thammasat University Hospital, Pathumthani, Thailand
| | - Alisa Moriguchi
- Department of Surgery, Faculty of Medicine, Thammasat University, Thammasat University Hospital, Pathumthani, Thailand
| | - Amonpon Kanlerd
- Department of Surgery, Faculty of Medicine, Thammasat University, Thammasat University Hospital, Pathumthani, Thailand
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Kollatos C, Hanna S, Sandblom G. Impact of the COVID-19 pandemic on hernia surgery in a Swedish healthcare region: a population-based cohort study. BMC Surg 2022; 22:260. [PMID: 35790926 PMCID: PMC9255440 DOI: 10.1186/s12893-022-01698-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/23/2022] [Indexed: 12/24/2022] Open
Abstract
Background Swedish healthcare has been reorganised during the COVID-19 pandemic, affecting the availability of surgery for benign conditions. The aim of this study was to determine the effects of COVID-19 on emergency and elective hernia surgery in a Swedish healthcare region. Methods Using procedure codes, data from inguinal and ventral hernia procedures performed at the three hospitals in Jönköping Region, Sweden, from March 1st 2019 to January 31st 2021, were retrieved from a medical database. The cohort was divided into two groups: the COVID-19 group (March 1st 2020–January 31st 2021) and the control group (March 1st 2019–January 31st 2020). Demographic and preoperative data, hernia type, perioperative findings, and type of surgery were analysed. Results A total 1329 patients underwent hernia surgery during the study period; 579 were operated during the COVID-19 period and 750 during the control period. The number of emergency ventral hernia repairs increased during the COVID-19 period, but no difference in inguinal hernia repair rate was seen. The characteristics of patients that underwent hernia repair were similar in the two groups. Moreover, the decrease in elective ventral hernia repair rate during the COVID-19 period did not result in a higher risk for strangulation. Conclusion There is no evidence to suggest that the decrease in the number of elective ventral hernia repairs during the COVID-19 period had any impact on the risk for strangulation. Indications for surgery in patients with a symptomatic ventral or inguinal hernia should be carefully evaluated. Studies with greater power and longer follow-up are needed to gain a full understanding of the effects of the COVID-19 pandemic on hernia surgery.
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Affiliation(s)
- Christos Kollatos
- Department of Surgery, Ryhov County Hospital, 55185, Jönköping, Sweden.
| | - Sarmad Hanna
- Department of Surgery, Kalmar Hospital, Kalmar, Sweden
| | - Gabriel Sandblom
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden.,Department of Surgery, Södersjukhuset, Stockholm, Sweden
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Turhan N, Arıcan ÇD. The effects of COVID-19 pandemic on patients with acute appendicitis. ULUS TRAVMA ACIL CER 2022; 28:756-761. [PMID: 35652875 PMCID: PMC10443006 DOI: 10.14744/tjtes.2021.53929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/19/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The effects of the COVID-19 infection on the world's health system began to be reported in a short time, with the spread of the infection all over the world and it gained a global acceptance as a pandemic. It was predicted that patients who require urgent surgical procedures may not be able to access appropriate treatment during this period and may suffer from this process. In this process, we planned to report the effects of the pandemic process to this patient group by evaluating patients with acute appendicitis, which is the most common cause of acute abdomen among general surgery emergencies. METHODS In our study, we compared the patients who applied to the Training and Research Hospital we collaborated, whose clinics were compatible with acute appendicitis, between March 11, 2020, and May 21, 2020, with those applied within the same time period with the year before. We evaluated clinical and pathological findings of the patients and the treatment applied. RESULTS In this study, there were 103 patients diagnosed with acute appendicitis before pandemic and 61 in pandemic period. We found that during the pandemic period, patients with acute appendicitis were admitted to the hospital less often, and in a later period, and more complicated clinical pictures were determined. Complicated appendicitis patients were higher in pandemic period compared with previous year (33.96% vs. 8.00% of patients, respectively; p<0.05). CONCLUSION We emphasized that diseases that need to be treated urgently should not be left behind during the pandemic. Furthermore, we shared our clinical practice to ensure early discharge of patients with acute appendicitis during the pandemic process.
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Affiliation(s)
- Nihan Turhan
- Department of General Surgery, Martyr Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital, İstanbul-Turkey
| | - Çiğdem Dicle Arıcan
- Department of Medical Pathology, Martyr Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital, İstanbul-Turkey
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Tankel J, Keinan A, Gillis R, Yoresh M, Gillis M, Tarnovsky Y, Riessman P. Exploring the trends of acute appendicitis following recovery or vaccination from COVID-19. J Surg Res 2022; 279:633-638. [PMID: 35926313 PMCID: PMC9234038 DOI: 10.1016/j.jss.2022.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 05/06/2022] [Accepted: 06/08/2022] [Indexed: 11/06/2022]
Abstract
Introduction The relationship that vaccination against corona virus disease 19 (COVID-19) or recovery from the acute form of the illness may have with the incidence or severity of acute appendicitis (AA) has not been explored. The aim of this study was to evaluate this relationship. Methods A single centre retrospective study of all consecutive adult patients presenting with AA in the 6 mo after the initiation of a national vaccination program was performed. The presenting characteristics and pathological data of patients who had either been vaccinated against or recovered from COVID-19 were compared with those who had not. In addition, historical data from the equivalent period 12 and 24 mo beforehand was also extracted. The incidence of AA was compared between each of these time-frames. Results Of the 258 patients initially identified, 255 were included in the analysis of which 156 had either been vaccinated and/or recovered from COVID-19 (61.2%) whilst 99 (38.8%) patients had not. When comparing these two groups, there were no significant differences in the presenting characteristics, operative findings or postoperative courses. There was also no significant change in the incidence of AA when comparing the study dates with historical data (median weekly incidence of AA 8.0 versus 8.0 versus 8.0 respectively, P = 0.672). Conclusions Based on the data presented here, we failed to find a relationship between a national vaccination program and both the nature and incidence of AA presenting to a busy urban hospital.
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Bhaskar J, McLean RC, Bhaskar K, Brown LR. Temporal Trends in the Investigation, Management and Outcomes of Acute Appendicitis over 15 Years in the North of England: A Retrospective Cohort Study. World J Surg 2022; 46:2141-2154. [PMID: 35585254 PMCID: PMC9116928 DOI: 10.1007/s00268-022-06586-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Acute appendicitis is a common surgical emergency with an estimated lifetime prevalence of 8.6% for males and 6.7% for females. Despite the frequency of presentation, considerable variation in clinical practice exists. Our study aimed to explore temporal trends in the investigation, treatment and outcomes for patients with appendicitis between 2002 and 2016. METHODS Data collected included all patients aged ≥16 years across the NHS trusts in Northern England between 01/01/2002 and 31/12/2016 diagnosed with appendicitis. Patient demographics, co-morbidity and management strategies were included. Outcomes of interest were length of stay and inpatient mortality. RESULTS Over a 15 years period, 22,137 patients were admitted with acute appendicitis. A consistent male preponderance (n = 11,952, 54%) was observed, and median age increased over time (2002-2006: 36.4 vs. 2012-2016: 39.5, p < 0.001). Comorbidity of patients also increased (p < 0.001) in recent years. Computed tomography (CT) use increased from 0.8 to 21.9% (p < 0.001) over the study period. Following CT scanning, there was a longer time to theatre (1.22 vs. 0.70 days, p < 0.001), and patients were more frequently managed non-operatively (23.8% vs. 5.7%, p < 0.001). The utilisation of laparoscopic approaches significantly increased from 4.1 to 70.4% (p < 0.001). Laparoscopic patients had a shorter median length of stay (2.97 days) when compared with open surgery (4.44 days) or non-operative (6.19 days) patients. The 30-day mortality rate was 0.33% overall and decreased with time (p = 0.004). CONCLUSIONS CT and laparoscopic surgery are increasingly utilised in the management of appendicitis. Along with other advances in clinical practice, they have led to reduced lengths of stay and mortality.
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Affiliation(s)
- Jared Bhaskar
- St George's University of London, Cranmer Terrace, Tooting, London, SW17 0RE, England, UK.
| | - Ross C McLean
- Queen Elizabeth Hospital Site, Queen Elizabeth Avenue, Gateshead, NE9 6SX, England, UK
| | - Keir Bhaskar
- Department of Medicine, Imperial College London, Exhibition Road, South Kensington, London, SW7 2BX, England, UK
| | - Leo R Brown
- Royal Infirmary of Edinburgh, Little France, Edinburgh, EH2 2EQ, Scotland, UK
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Turan U, Dirim AB. The effects of COVID-19 pandemic on emergency anterior abdominal wall hernia surgery: is it safe to postpone elective hernia surgery in the pandemic? Eur J Trauma Emerg Surg 2022; 48:833-839. [PMID: 34605962 PMCID: PMC8489365 DOI: 10.1007/s00068-021-01803-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/28/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND The aim of this study was to investigate the effects of the COVID-19 pandemic on emergency anterior abdominal wall hernia surgeries (EAAWHS) by comparing the pandemic period with the control period a year ago and to share our experiences in the pandemic period. METHODS This single-center retrospective cohort study included all patients who underwent EAAWHS during the pandemic (from 11 March 2020 to 25 January 2021) and control period (1 year before the same period, from 11 March 2019 to 25 January 2020). Demographic data, preoperative clinical and pathological parameters, intraoperative findings and postoperative complications secondary to operation and COVID-19 infection, length of intensive care and hospital stay of patients were recorded, and the pandemic and control groups were compared. RESULTS Of the 87 patients who underwent anterior abdominal wall hernia surgery during the COVID-19 pandemic, 41 (47.1%) were operated emergently and 46 (52.9%) were operated electively. Of the 485 patients who underwent anterior abdominal wall hernia surgery during the control period, 24 (4.95%) were operated emergently and 461 (95.05%) were operated electively. The decrease in the number of elective operations and the increase in the number of emergency operations were significant during the pandemic (p < 0.001).There was a decrease in the number of emergency inguinal hernia operations and an increase in the number of emergency ventral (incisional, umbilical) hernia operations during the pandemic period compared to the control period (p < 0.05).The mortality rates were similar (8.3 vs. 9.8%, p > 0.05) in both periods. CONCLUSION Despite the increase in the number of EAAWHS during the COVID-19 pandemic, there was no significant difference in mortality and morbidity rates. EAAWHS can be performed safely during the pandemic by taken necessary and adequate precautions.
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Affiliation(s)
- Umit Turan
- Department of General Surgery, Adana City Research and Training Center, Saglik Bilimleri University, Adana, Turkey
| | - Ahmet Baris Dirim
- Department of General Surgery, Adana City Research and Training Center, Saglik Bilimleri University, Adana, Turkey
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An S, Kim HR, Jang S, Kim K. The Impact of the Coronavirus Disease - 19 Pandemic on the Clinical Characteristics and Treatment of Adult Patients with Acute Appendicitis. Front Surg 2022; 9:878534. [PMID: 35433818 PMCID: PMC9009369 DOI: 10.3389/fsurg.2022.878534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/21/2022] [Indexed: 01/08/2023] Open
Abstract
PurposeThis study aimed to investigate the characteristics, severity, and treatment of adult patients with acute appendicitis in Korea over a 2-year period during the coronavirus disease (COVID-19) pandemic compared to those before the pandemic. We also investigated whether there were any changes in clinical characteristics of acute appendicitis before and after vaccination against the coronavirus.MethodsWe retrospectively reviewed the medical records of patients who were diagnosed with acute appendicitis at our institution between March 1, 2019, and August 31, 2021. We divided the patients into three groups (pre-pandemic, before vaccination, and after vaccination) and analyzed the clinical outcomes.ResultsThe time from symptom onset to hospital arrival and the time from symptom onset to operation increased during the COVID-19 pandemic period compared to the pre-pandemic period. The rate of complicated appendicitis during the pandemic was higher than that before the pandemic. In addition, the number of new daily cases showed a positive correlation with the time from symptom onset to hospital arrival (OR, 0.03; 95% CI, 0.02 to 0.04; P < 0.001) and complicated appendicitis (OR, 1.002; 95% CI, 1.001–1.002; P = 0.0017). The vaccination rate showed a negative correlation with the time from symptom onset to hospital arrival (OR, −2.26; 95% CI, −3.42 to −1.11; P < 0.001) and complicated appendicitis (OR, 0.915; 95% CI, 0.84 to 0.996; P = 0.0404).ConclusionsEmploying hospital-wide efforts, such as screening by rapid PCR testing, to avoid further time delays, and nationwide efforts, such as vaccination, to shorten the time from symptom onset to hospital arrival, are necessary to maintain the quality of treatment of acute appendicitis during an infectious disease pandemic.
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Affiliation(s)
- Sanghyun An
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hae-Rim Kim
- College of Natural Science, School of Statistics, University of Seoul, Seoul, Korea
| | - Sungwoo Jang
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Kwangmin Kim
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
- Correspondence: Kwangmin Kim
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Alakuş Ü, Türker B, Sarıgöz T, Mehmet Meral U. Impact of coronavirus disease on acute appendicitis cases. ULUS TRAVMA ACIL CER 2022; 28:285-289. [PMID: 35485557 PMCID: PMC10493522 DOI: 10.14744/tjtes.2020.38632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/04/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Disease profiles have changed in the COVID-19 pandemic. In this study, we aimed to compare acute appendicitis cases before and during the COVID-19 pandemic. METHODS A total of 130 patients were diagnosed with AA and operated between the days of first COVID-19 case on March 11, 2020, and May 11, 2020, and the same period of the previous year. Data of the patients were extracted from electronic archive of the hospital. Those patients were stratified into two groups; pandemic group and pre-pandemic group. The pandemic group comprised 46 patients and the pre-pandemic group, 84 patients. The two groups were compared in terms of age, gender, duration of symptoms, length of hospital stay, white blood cell count, C-reactive protein levels, and post-operative complications. RESULTS The median days passed from onset of abdominal pain to submission were 6.5 days in the pandemic period. However, it was 3 days in the pre-pandemic group (p<0.001). Other parameters were not statistically different between the groups (p>0.05). CONCLUSION During the COVID-19 pandemic period, delay in hospital submissions has attracted attention. However, delayed treatment did not reflect to the clinic as more severe disease.
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Affiliation(s)
- Ümit Alakuş
- Department of General Surgery, Health Sciences University Gülhane Training and Research Hospital, Ankara-Turkey
| | - Barış Türker
- Department of General Surgery, Batman State Hospital, Batman-Turkey
| | - Talha Sarıgöz
- Department of General Surgery, Kayseri City Hospital, Department of General Surgery, Kayseri-Turkey
| | - Ulvi Mehmet Meral
- Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir-Turkey
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Abstract
BACKGROUND This study aimed to assess the severity of appendicitis during the coronavirus disease 2019 (COVID-19) pandemic, as patients with appendicitis may procrastinate seeking medical attention during the pandemic. METHODS Information on patients with appendicitis who were treated at the Taipei City Hospital during the COVID-19 pandemic (January 1, 2020 to June 30, 2020) was retrieved. Patients who were diagnosed with appendicitis and treated at the same hospital from January 1, 2019 to July 1, 2019 were designated as the control group. Multivariate logistic regression analysis was conducted to assess changes in the severity of appendicitis (at a 2-week interval) between the two groups. RESULTS We identified 307 (study group: 149; control group: 158) consecutive patients with appendicitis. The mean age was 46.2 +- 19.8 years. Between the two groups, there were no significant differences in age, sex, comorbidity, surgery type (laparoscopic or open appendectomy) or surgery time. The number of patients in the study group decreased between January 29, 2020 and April 21, 2020, which paralleled the period of spikes in the confirmed COVID-19 cases and restricted daily activities. The percentage of uncomplicated and complicated appendicitis (excluding mild appendicitis or normal appendix) in the study group increased between February 26 and March 10, as well as between April 8 and April 21. In the multivariate regression analysis, the odds of uncomplicated and complicated appendicitis increased in three bi-weeks for the study group but not in the control group. CONCLUSION The severity of acute appendicitis might increase during the COVID-19 pandemic, because patients with mild appendicitis (or abdominal pain) may hesitate to seek help.
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Affiliation(s)
- Yao-Jen Chang
- Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Li-Ju Chen
- University of Taipei, Taipei, Taiwan
- Department of Ophthalmology, HepingFuyou Branch, Taipei City Hospital, Taipei, Taiwan
| | - Yun-Jau Chang
- Department of General Surgery, National Taiwan University Hospital, Taipei, Taiwan
- Department of General Surgery, Zhong-Xing Branch, Taipei City Hospital, Taipei, Taiwan
- * E-mail:
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14
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Lisi G, Campanelli M, Mastrangeli MR, Spoletini D, Menditto R, Grande S, Boccuzzi M, Grande M. The treatment of acute appendicitis in two age-based groups during COVID-19 pandemic: a retrospective experience in a COVID-19 referral hospital. Int J Colorectal Dis 2022; 37:323-328. [PMID: 34738164 PMCID: PMC8567973 DOI: 10.1007/s00384-021-04060-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE During the past months, the Italian Government has reduced the restrictions and access to hospitals as well as outpatient. Since then, up to 40% of non-traumatic abdominal emergencies have had unusual delayed treatment. Given the rapidly evolving situation and the absence of evidence to support recommendations during the COVID-19 pandemic, it is useful to assess how the current situation is influencing the management of elderly patients with acute appendicitis. METHODS Between February 2020 and December 2020, all patients 18 years or older undergone appendectomy were included. Patients were divided in two age-based groups (young groups, YG; elderly group, EG). Surgical approach, hospital stay, post-operative complications, radiology reports, and histologic examination were included in the retrospective analysis. RESULTS One hundred eight patients underwent appendectomy, 81 patients into the YG, and 27 in the EG. Laparoscopy was performed in 87.7% of the YG and in 51.8% of the elderly (p < 0.000), while conversion to laparotomy was necessary in 3.7% in the YG vs 22.3% of the other group (p < 0.009). Open procedures were more frequent in the EG, 25.9% vs 8.6% (p value < 0.05). No mortality rate was reported in both groups; moreover, the mean hospital stay was greater in the EG than the YG (p < 0.000). CONCLUSION Our data highlighted a partial delay in diagnosis in the elderly group, and an increase in complicated appendicitis also demonstrated by the need for conversion to laparotomy despite no significant relationship between these findings and the histologic examination was reported.
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Affiliation(s)
- Giorgio Lisi
- Department of Surgery, Sant'Eugenio Hospital, Piazzale dell'Umanesimo 10, 00144, Rome, Italy.
| | - Michela Campanelli
- Emergency Surgery Unit, University Hospital of Tor Vergata, viale Oxford 81, 00133, Rome, Italy
| | | | - Domenico Spoletini
- Department of Surgery, Sant'Eugenio Hospital, Piazzale dell'Umanesimo 10, 00144, Rome, Italy
| | - Rosa Menditto
- Department of Surgery, Sant'Eugenio Hospital, Piazzale dell'Umanesimo 10, 00144, Rome, Italy
| | - Simona Grande
- Emergency Surgery Unit, University Hospital of Tor Vergata, viale Oxford 81, 00133, Rome, Italy
| | - Massimiliano Boccuzzi
- Department of Surgery, San Sebastiano Hospital, via Tuscolana 1, 00046, Frascati, Rome, Italy
| | - Michele Grande
- Emergency Surgery Unit, University Hospital of Tor Vergata, viale Oxford 81, 00133, Rome, Italy
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Zhang P, Zhang Q, Zhao HW. COVID-19 pandemic changed the management and outcomes of acute appendicitis in northern Beijing: A single-center study. World J Clin Cases 2022; 10:820-829. [PMID: 35127898 PMCID: PMC8790446 DOI: 10.12998/wjcc.v10.i3.820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/27/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, outcomes and management of many diseases have been affected. Acute appendicitis is a common acute abdomen. The incidence rate is 0.05%-0.5%. Studies reported that the number of patients with appendicitis admitted to emergency department significantly decreased since the pandemic. People avoided going to the hospital for fear of being infected. Different countries have different epidemic prevention measures that result in different treatment outcomes. The Chinese government also published some temporary measures in order to prevent the outbreak.
AIM To explore the changes in management and outcomes of acute appendicitis during the COVID-19 pandemic in the North of Beijing.
METHODS Patients with acute appendicitis admitted to Beijing Tsinghua Changgung Hospital between February and June 2019 and February and June 2020 were retrospectively reviewed. Cases were grouped according to admission year. The demographic characteristics, present illnesses, medical history, symptoms and signs, comorbidities, blood test results, imaging data, appendix pathology, and treatment details were compared.
RESULTS Overall, 74 patients received nonsurgical treatment and 113 patients underwent surgical treatment in group 2019, whereas 159 patients received nonsurgical treatment and 26 patients received surgical treatment in group 2020. Fever, thick appendix, nonsurgical management, and uncomplicated appendicitis (simple or supportive appendicitis) were more common in group 2020 (P < 0.05). Among the nonsurgical management cases, the neutrophil percentage, neutrophil-to-lymphocyte ratio, and recurrence rate were higher in group 2020 (P < 0.05). Among surgically managed cases, there were more cases with gastrointestinal symptoms, peritonitis, ascites in the image, and intraoperative adhesion or ascites in group 2020 (P < 0.05). The white blood cell count, time from diagnosis to surgery, surgical time, and intraoperative blood loss were higher in group 2020 (P < 0.05).
CONCLUSION During the COVID-19 pandemic, patients suffering from acute appendicitis in Beijing tended to present with severe symptoms and opt for nonsurgical treatment. For patients who underwent surgical management, the operation was delayed and more difficult during the pandemic. Nevertheless, the hospital stay and the incidence of postsurgical complications did not change.
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Affiliation(s)
- Peng Zhang
- Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Qian Zhang
- Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Hong-Wei Zhao
- Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
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Pogorelić Z, Anand S, Žuvela T, Singh A, Križanac Z, Krishnan N. Incidence of Complicated Appendicitis during the COVID-19 Pandemic versus the Pre-Pandemic Period: A Systematic Review and Meta-Analysis of 2782 Pediatric Appendectomies. Diagnostics (Basel) 2022; 12:127. [PMID: 35054293 PMCID: PMC8774400 DOI: 10.3390/diagnostics12010127] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/29/2021] [Accepted: 01/05/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The Coronavirus Disease 2019 (COVID-19) pandemic has impacted volume, management strategies and patient outcomes of acute appendicitis. The aim of this systematic review and meta-analysis was to evaluate whether the COVID-19 pandemic resulted in higher incidence of complicated appendicitis in children presenting with acute appendicitis compared to the pre-COVID-19 period. The secondary aim was to investigate the proportion of the patients treated by non-operative management (NOM). METHODS A systematic search of four scientific databases was performed. The search terms used were (coronavirus OR SARS-CoV-2 OR COVID-19 OR novel coronavirus) AND (appendicitis). The inclusion criteria were all patients aged <18 years and diagnosed with acute appendicitis during the COVID-19 and pre-COVID-19 periods. The proportion of children presenting with complicated appendicitis and the proportion of children managed by NOM was compared between the two groups. The Downs and Black scale was used for methodological quality assessment. RESULTS The present meta-analysis included thirteen studies (twelve retrospective studies and one cross-sectional study). A total of 2782 patients (1239 during the COVID-19 period) were included. A significantly higher incidence of complicated appendicitis (RR = 1.63, 95% CI 1.33-2.01, p < 0.00001) and a significantly higher proportion of children managed via the NOM (RR = 1.95, 95% CI 1.45-2.61, p < 0.00001) was observed in patients during the COVID-19 pandemic when compared to the pre-COVID-19 period. CONCLUSION There is a significantly higher incidence of complicated appendicitis in children during the COVID-19 pandemic than in the pre-COVID-19 period. Additionally, a significantly higher proportion of children was managed via the NOM during the pandemic in comparison to the pre-pandemic period.
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Affiliation(s)
- Zenon Pogorelić
- Department of Pediatric Surgery, University Hospital of Split, 21 000 Split, Croatia
- Department of Surgery, School of Medicine, University of Split, 21 000 Split, Croatia;
| | - Sachit Anand
- Department of Pediatric Surgery, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India;
| | - Tomislav Žuvela
- Department of Surgery, School of Medicine, University of Split, 21 000 Split, Croatia;
| | - Apoorv Singh
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi 110029, India; (A.S.); (N.K.)
| | - Zvonimir Križanac
- Department of Surgery, University Hospital of Split, 21 000 Split, Croatia;
| | - Nellai Krishnan
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi 110029, India; (A.S.); (N.K.)
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Moghadamyeghaneh Z, Ojo A, Rahimi M, Kopatsis AP, Kopatsis K, Kopatsis A. The Economic Effects on Acute Care Surgery in a New York City Public Hospital During the COVID Pandemic. Am Surg 2022:31348211069788. [DOI: 10.1177/00031348211069788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Since the start of the COVID-19 pandemic, less acute care surgical procedures have been performed and consequently hospitals have experienced significant revenue loss. We aim to investigate these procedures performed before and after the start of the COVID-19 pandemic, as well as their effect on the economy. Methods This is a retrospective analysis of patients who underwent cholecystectomies and appendectomies during March–May 2019 compared to the same time period in 2020 using Chi-square and t-tests. Results There were 345 patients who presented with appendicitis or cholecystitis to Elmhurst Hospital Center during the March–May 2019 and 2020 time period. There were three times as many total operations, or about 75%, in 2019 (261) compared to 2020 (84). There was a decrease in the number of admissions from 2019 to 2020 for both acute cholecystitis (149 vs 43, respectively) and acute appendicitis (112 vs 41, respectively). The largest decrease in the number of admissions in 2020 compared to 2019 was observed in April 2020 (98 vs 9, P < .01) followed by May [69 vs 20, P < .01], and March [94 vs 55, P < .01]. Corresponding to the decrease in operative patterns was a noticeable six-time reduction in revenue for the procedures in 2019 ($187,283) compared to 2020 ($30,415). Conclusion We observed almost a triple reduction in the number of cholecystitis and appendicitis procedures performed during the 2020 pandemic surge as compared to the 2019 pre-pandemic data. Elmhurst hospital also experienced four times the loss of revenue during the same time period.
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Affiliation(s)
| | - Adedolapo Ojo
- Department of Surgery, NYC Health and Hospitals-Elmhurst, Queens, NY, USA
| | - Murwarid Rahimi
- Department of Surgery, NYC Health and Hospitals-Elmhurst, Queens, NY, USA
| | | | - Katherine Kopatsis
- Department of Surgery, NYC Health and Hospitals-Elmhurst, Queens, NY, USA
| | - Anthony Kopatsis
- Department of Surgery, NYC Health and Hospitals-Elmhurst, Queens, NY, USA
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18
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Abstract
BACKGROUND Appendicitis is the most common abdominal surgical emergency in children. With the rise of the Coronavirus-19 pandemic, quarantine measures have been enforced to limit the viral transmission of this disease. The purpose of this study was to identify differences in the clinical presentation and outcomes of pediatric acute appendicitis during the Coronavirus-19 pandemic. METHODS A single-institution retrospective assessment of all pediatric patients (<18 years old) with acute appendicitis from December 2019 to June 2020 was performed at a tertiary care children's hospital. Patients were divided into two groups: (1) the Pre-COVID group presented on or before March 15, 2020, and (2) the COVID group presented after March 15, 2020. Demographic, preoperative, and clinical outcomes data were analyzed. RESULTS 45 patients were included with a median age of 13 years [IQR 9.9 - 16.2] and 35 males (78%). 28 patients were in the Pre-COVID group (62%) and 17 in the COVID group (38%). There were no differences in demographics or use of diagnostic imaging. The COVID group did have a significantly delayed presentation from symptom onset (36 vs 24 hours, P < .05), higher Pediatric Appendicitis Scores (8 vs 6, P = .003), and longer hospital stays (2.2 vs 1.3 days, P = .04). There were no significant differences for rates of re-admission, re-operation, surgical site infection, perforation, or abscess formation. CONCLUSION During the Coronavirus-19 pandemic, the incidence of pediatric acute appendicitis was approximately 40% lower. These children presented in a delayed fashion with longer hospital stays. No differences were noted for postoperative complications.
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Affiliation(s)
- William T Head
- College of Medicine, 158155Medical University of South Carolina, Charleston, SC, USA
| | - Raphael H Parrado
- Division of Pediatric Surgery, Department of Surgery, 2345Medical University of South Carolina, Charleston, SC, USA
| | - Robert A Cina
- Division of Pediatric Surgery, Department of Surgery, 2345Medical University of South Carolina, Charleston, SC, USA
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Teng TZJ, Thong XR, Lau KY, Balasubramaniam S, Shelat VG. Acute appendicitis–advances and controversies. World J Gastrointest Surg 2021; 13:1293-1314. [PMID: 34950421 PMCID: PMC8649565 DOI: 10.4240/wjgs.v13.i11.1293] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/24/2021] [Accepted: 09/29/2021] [Indexed: 02/06/2023] Open
Abstract
Being one of the most common causes of the acute abdomen, acute appendicitis (AA) forms the bread and butter of any general surgeon’s practice. With the recent advancements in AA’s management, much controversy in diagnostic algorithms, possible differential diagnoses, and weighing the management options has been generated, with no absolute consensus in the literature. Since Alvarado described his eponymous clinical scoring system in 1986 to stratify AA risk, there has been a burgeoning of additional scores for guiding downstream management and mortality assessment. Furthermore, advancing literature on the role of antibiotics, variations in appendicectomy, and its adjuncts have expanded the surgeon’s repertoire of management options. Owing to the varied presentation, diagnostic tools, and management of AA have also been proposed in special groups such as pregnant patients, the elderly, and the immunocompromised. This article seeks to raise the critical debates about what is currently known about the above aspects of AA and explore the latest controversies in the field. Considering the ever-evolving coronavirus disease 2019 situation worldwide, we also discuss the pandemic’s repercussions on patients and how surgeons’ practices have evolved in the context of AA.
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Affiliation(s)
- Thomas Zheng Jie Teng
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Department of Undergraduate Medicine, Lee Kong Chian School of Medicine, Singapore 308232, Singapore
| | - Xuan Rong Thong
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Department of Undergraduate Medicine, Lee Kong Chian School of Medicine, Singapore 308232, Singapore
| | - Kai Yuan Lau
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Department of Undergraduate Medicine, Lee Kong Chian School of Medicine, Singapore 308232, Singapore
| | | | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Department of Undergraduate Medicine, Lee Kong Chian School of Medicine, Singapore 308232, Singapore
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21
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Karlafti E, Benioudakis ES, Paramythiotis D, Sapalidis K, Kaiafa G, Didangelos T, Michalopoulos A, Kesisoglou I, Savopoulos C. Does the COVID-19 Pandemic Affect Morbidity and Mortality Rates of Emergency General Surgery? A Retrospective Study from a Single-Center Tertiary Greek Hospital. Medicina (Kaunas) 2021; 57:1185. [PMID: 34833403 DOI: 10.3390/medicina57111185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 12/29/2022]
Abstract
Background and Objectives: The outbreak of the COVID-19 pandemic had a major impact on all aspects of health care. Few up-to-date studies have actually assessed the impact of COVID-19 on emergency surgeries. The aim of this study was to provide an overview of the impact of the pandemic relating to the emergency surgery performed, as well as morbidity and mortality rates during the first year of the pandemic (March 2020–February 2021) and during the control period. In this period, the first propaedeutic surgery department and the third surgery department of the University General Hospital of Thessaloniki “AHEPA” in Greece provided continuous emergency general surgery services. Material and Methods: The study is in a retrospective cohort and included patients who were admitted to the Emergency Department and underwent emergency general surgery during the control period (n = 456), March 2019–February 2020 and during the first year of the pandemic (n = 223), March 2020–February 2021. Gender, age, type of surgical operation (morbidity), ICU need, the patient’s outcome, and days of hospitalization were compared. Results: A total of 679 emergency surgeries were included. Statistically significant differences emerged between the two time periods in the total number of emergency surgeries performed (p < 0.001). The most common type of surgery in the control period was associated with soft tissue infection while, during the pandemic period, the most common type of surgery was associated with the hepatobiliary system. In addition, the mortality rates nearly doubled during the pandemic period (2.2% vs. 4%). Finally, the mean age of our sample was 50.6 ± 17.5 and the majority of the participants in both time periods were males. Conclusions: The COVID-19 pandemic changed significantly the total number of emergency general surgeries performed. Mortality rates doubled and morbidity rates were affected between the control and pandemic periods. Finally, age, gender, length of hospitalization, intensive care unit hospitalization, and laparoscopy use in patients undergoing emergency surgery during the pandemic were stable.
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22
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Guadalajara H, Muñoz de Nova JL, Yiasemidou M, Recarte Rico M, Juez LD, García Septiem J, Galindo Jara P, García Virosta M, Lobo Martínez E, Martín-Pérez E, Fernandez Gonzalez S, Lopez-Fernandez O, García-Olmo D; PIACO Collaboration Group. The SARS-CoV-2 first wave impact in the acute inflammatory surgical pathologies. Sci Rep 2021; 11:19645. [PMID: 34608197 DOI: 10.1038/s41598-021-98878-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 09/13/2021] [Indexed: 12/29/2022] Open
Abstract
Anecdotal evidence suggests that community infection control measures during the COVID-19 outbreak have modified the number and natural history of acute surgical inflammatory processes (ASIP—appendicitis, cholecystitis, diverticulitis and perianal abscesses) admissions. This study aims to evaluate the impact of the COVID-19 pandemic on the presentation and treatment ASIP and quantify the effect of COVID-19 infection on the outcomes of ASIP patients. This was a multicentre, comparative study, whereby ASIP cases from 2019, 2020 and 2021 (March 14th to May 2nd) were analyzed. Data regarding patient and disease characteristics as well as outcomes, were collected from sixteen centres in Madrid, and one in Seville (Spain). The number of patients treated for ASIP in 2019 was 822 compared to 521 in 2020 and 835 in 2021. This 1/3rd reduction occurs mainly in patients with mild cases, while the number of severe cases was similar. Surgical standards suffered a step back during the first wave: Lower laparoscopic approach and longer length of stay. We also found a more conservative approach to the patients this year, non-justified by clinical circumstances. Luckily these standards improved again in 2021. The positive COVID-19 status itself did not have a direct impact on mortality. Strikingly, none of the 33 surgically treated COVID positive patients during both years died postoperatively. This is an interesting finding which, if confirmed through future research with a larger sample size of COVID-19 positive patients, can expedite the recovery phase of acute surgical services.
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23
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Lisi G, Campanelli M, Mastrangeli MR, Grande S, Viarengo MA, Garbarino GM, Vanni G, Grande M. Acute appendicitis in elderly during Covid-19 pandemic. Int J Colorectal Dis 2021; 36:2287-2290. [PMID: 34046696 PMCID: PMC8159028 DOI: 10.1007/s00384-021-03959-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE During the past months, the Italian Government has reduced the restrictions and access to hospitals. Since then, up to 40% of non-traumatic abdominal emergencies have had unusual delayed treatment. Given the rapidly evolving situation and the absence of evidence to support recommendations during the pandemic, it is useful to assess how the current situation is influencing the management of elderly with acute appendicitis. METHODS Between February 2020 and December 2020, all patients older than 68 years old undergone appendectomy were included. Surgical approach, hospital stay, post-operative complications, radiology reports, and histologic examination were included in the retrospective analysis and compared with a same sample of the same period before the pandemic. RESULTS Twenty-seven patients underwent appendectomy for acute appendicitis during the pandemic and 34 patients in the pre-outbreak period. Laparoscopic approach was completed in 51.8% of the cases, while conversion to laparotomy in 22.3% of patients and open procedure in the 25.9%, before the pandemic 73.6%, 14.7%, and 11.7%, respectively. During the pandemic, complicated appendicitis occurred in 59.3% of the cases (26.5% before the outbreak). One patient was treated for a pelvic abscess, while no minor complications were detected. No mortality rate was reported, with a mean hospital stay of 5.64 days during the outbreak and 4.21 days before the pandemic. CONCLUSION Our data highlighted a partial delay in diagnosis in the elderly group, and an increase in complicated appendicitis also demonstrated by the need for conversion to laparotomy.
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Affiliation(s)
- G Lisi
- Department of Surgery, Sant'Eugenio Hospital, Piazzale dell'Umanesimo 10, 00144, Rome, Italy.
| | - M Campanelli
- Emergency Surgery Unit, University Hospital of Tor Vergata, viale Oxford 81, 00133, Rome, Italy
| | - M R Mastrangeli
- Department of Surgery, Sant'Eugenio Hospital, Piazzale dell'Umanesimo 10, 00144, Rome, Italy
| | - S Grande
- Emergency Surgery Unit, University Hospital of Tor Vergata, viale Oxford 81, 00133, Rome, Italy
| | - M A Viarengo
- Day-Case Surgery Unit, Israelitic Hospital, 00144, Rome, Italy
| | - G M Garbarino
- Department of Medical Surgical Sciences and Translational Medicine, Sant'Andrea University, Via di Grottarossa, 1035-39, 00189, Rome, Italy
| | - G Vanni
- Emergency Surgery Unit, University Hospital of Tor Vergata, viale Oxford 81, 00133, Rome, Italy
| | - M Grande
- Emergency Surgery Unit, University Hospital of Tor Vergata, viale Oxford 81, 00133, Rome, Italy
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24
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Al Hashmi FY, Al Zuabi A, Hachim IY, Mannaerts GHH, Bekdache O. Conservative management of acute appendicitis in the era of COVID 19: A multicenter prospective observational study at the United Arab Emirates. Int J Surg Open 2021; 36:100389. [PMID: 34568625 PMCID: PMC8386107 DOI: 10.1016/j.ijso.2021.100389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/05/2021] [Accepted: 08/07/2021] [Indexed: 12/17/2022]
Abstract
Background & Aims Since its emergence in December 2019, the COVID-19 pandemic resulted in a profound impact on the health care system worldwide. We propose herein to evaluate the impact of implementing conservative management as an alternative approach to surgical appendectomy during COVID19 pandemic. Materials and Methods Our study is a prospective multicenter study that includes a cohort of 158 patients admitted to the surgical departments in both Tawam Hospital and SSMC hospital, Abu Dhabi, UAE, from February 2020 till July 2020. Results Our results showed a significant decrease in length of hospital stay (LOS) (2.32 ± 0.83 days) among conservatively treated group compared to the surgically treated group (2.8 ± 1.47 days). Also, short term follow-up showed that 90% of those patients did not require further operative intervention or developed complications. Out of the 110 patients that were swapped for COVID19, nine (8.18%) were confirmed to be positive. Our protocol was to avoid surgical management for COVID19 positive patients unless indicated. This resulted in (8/9) of COVID19 positive patients to be treated conservatively. Conclusions In conclusion, our results showed that the implementation of conservative management in treating patients with acute appendicitis who were COVID19 positive maybe essential in reducing viral transmission risks as well as avoiding operative risks on COVID19 positive patients.
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Affiliation(s)
- Fatima Y Al Hashmi
- General Surgery Division, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Abeer Al Zuabi
- General Surgery Division, Tawam Hospital, Al Ain, United Arab Emirates
| | - Ibrahim Yaseen Hachim
- Clinical Sciences Department, College of Medicine, University of Sharjah, United Arab Emirates
- Sharjah Institute for Medical Research, University of Sharjah, United Arab Emirates
| | | | - Omar Bekdache
- Trauma Service, Tawam Hospital, Al Ain, United Arab Emirates
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25
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Saalabian K, Rolle U, Friedmacher F. Impact of the Global COVID-19 Pandemic on the Incidence, Presentation, and Management of Pediatric Appendicitis: Lessons Learned from the First Wave. Eur J Pediatr Surg 2021; 31:311-318. [PMID: 34161983 DOI: 10.1055/s-0041-1731295] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The fast-evolving nature of the coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented clinical, logistical, and socioeconomical challenges for health-care systems worldwide. While several studies have analyzed the impact on the presentation and management of acute appendicitis (AA) in the adult population, there is a relative paucity of similar research in pediatric patients with AA. To date, there is some evidence that the incidence of simple AA in children may have decreased during the first lockdown period in spring 2020, whereas the number of complicated AA cases remained unchanged or increased slightly. Despite a worrying trend toward delayed presentation, most pediatric patients with AA were treated expediently during this time with comparable outcomes to previous years. Hospitals must consider their individual capacity and medical resources when choosing between operative and non-operative management of children with AA. Testing for severe acute respiratory syndrome coronavirus type 2 is imperative in all pediatric patients presenting with fever and acute abdominal pain with diarrhea or vomiting, to differentiate between multisystem inflammatory syndrome and AA, thus avoiding unnecessary surgery. During the further extension of the COVID-19 crisis, parents should be encouraged to seek medical care with their children early in order that the appropriate treatment for AA can be undertaken in a timely fashion.
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Affiliation(s)
- Kerstin Saalabian
- Department of Pediatric Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (Main), Germany
| | - Udo Rolle
- Department of Pediatric Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (Main), Germany
| | - Florian Friedmacher
- Department of Pediatric Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (Main), Germany
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26
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Esparaz JR, Chen MK, Beierle EA, Anderson SA, Martin CA, Mortellaro VE, Rogers DA, Mathis MS, Russell RT. Perforated Appendicitis during a Pandemic: The Downstream Effect of COVID-19 in Children. J Surg Res 2021; 268:263-266. [PMID: 34392179 PMCID: PMC8299184 DOI: 10.1016/j.jss.2021.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/07/2021] [Accepted: 07/10/2021] [Indexed: 12/18/2022]
Abstract
Introduction Coronavirus Disease-19 (COVID-19) was declared a pandemic in March 2020. States issued stay-at-home orders and hospitals cancelled non-emergent surgeries. During this time, we anecdotally noticed more admissions for perforated appendicitis. Therefore, we hypothesized that during the months following the COVID-19 pandemic declaration, more children were presenting with perforated appendicitis. Materials and Methods This is a retrospective cohort study reviewing pediatric patients admitted at a single institution with acute and/or perforated appendicitis between October 2019 to May 2020. Interval appendectomies were excluded. COVID-19 months were designated as March, April, and May 2020. Additional analysis of March, April, and May 2019 was performed for comparison purposes. Analyzed data included demographics, symptoms, white blood cell count, imaging findings, procedures performed, and perforation status. Statistical analysis was performed. Results During the study period, 285 patients were admitted with the diagnosis of acute appendicitis with 95 patients being perforated. We identified a significant increase in perforated appendicitis cases in the three COVID-19 months compared with the preceding five months (45.6% vs 26.4%; P <0.001). In addition, a similar significant increase was identified when comparing to the same months a year prior (P = 0.003). No significant difference in duration of pain was identified (P=0.926). Conclusion The COVID-19 pandemic and its associated stay-at-home orders have had downstream effects on healthcare. Our review has demonstrated a significant increase in the number of children presenting with perforated appendicitis following these stay-at-home ordinances. These results demonstrate that further investigations into the issues surrounding access to healthcare, especially during this pandemic, are warranted.
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Affiliation(s)
- Joseph R Esparaz
- Division of Pediatric Surgery, Children's of Alabama, Birmingham, AL; Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
| | - Mike K Chen
- Division of Pediatric Surgery, Children's of Alabama, Birmingham, AL; Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Elizabeth A Beierle
- Division of Pediatric Surgery, Children's of Alabama, Birmingham, AL; Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Scott A Anderson
- Division of Pediatric Surgery, Children's of Alabama, Birmingham, AL; Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Colin A Martin
- Division of Pediatric Surgery, Children's of Alabama, Birmingham, AL; Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Vincent E Mortellaro
- Division of Pediatric Surgery, Children's of Alabama, Birmingham, AL; Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - David A Rogers
- Division of Pediatric Surgery, Children's of Alabama, Birmingham, AL; Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Michelle S Mathis
- Division of Pediatric Surgery, Children's of Alabama, Birmingham, AL
| | - Robert T Russell
- Division of Pediatric Surgery, Children's of Alabama, Birmingham, AL; Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
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27
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Huamán Egoávil E, Lagrone L, Ugarte Oscco R, Endo Ramos S, Diaz Baltazar A, Vergel Cabrera C. SARS-CoV-2 infection is not associated with a higher rate of post-operative complications in adult appendectomy patients in Peru: Cross-sectional study. Ann Med Surg (Lond) 2021; 69:102582. [PMID: 34306672 PMCID: PMC8294597 DOI: 10.1016/j.amsu.2021.102582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 12/29/2022] Open
Abstract
Background We present outcomes of patients with SARS-CoV-2 undergoing appendectomy in order to aid in clarification of current controversies regarding safety of therapeutic options for emergency surgical diseases in patients with SARS-CoV-2. Peru has the greatest number of per capita deaths due to SARS-CoV-2 of any country and is one of few with a COVID-dedicated hospital. Materials and methods This prospective observational study included all adult patients with acute appendicitis admitted to an urban, public, COVID-dedicated hospital over two months. Baseline characteristics and post-operative outcomes at 28 days are reported. Results 58 patients, 35 male and 23 female, ages 15-73 years with SARS-CoV-2 as diagnosed by IgM (12%), IgG (19%) or both (69%) and acute appendicitis as diagnosed using the Alvarado Score and confirmed intraoperatively were enrolled. All patients presented with right lower quadrant pain, 86% with leukocytosis, 88% with nausea/emesis and no patients with respiratory complaints. All patients underwent open appendectomy, 90% under regional anesthesia. Average operative time was 54±25 minutes, length of stay 2.5±1.5 days. 14% of patients had a post-operative complication, all were minor, four (7%) incisional surgical site infections, one (2%) organ space, and three (5%) incisional seromas, no deaths or serious complications. Conclusion Open surgical management of acute appendicitis with regional anesthesia in adults with pre-operative diagnosis of SARS-CoV-2 is feasible and not associated with an increased frequency or severity of post-operative complications, longer operative time, or extended hospitalization as compared to reports in similar patients without SARS-CoV-2.
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Affiliation(s)
- Eduardo Huamán Egoávil
- Surgical Center of the Hospital Emergencia Ate Vitarte (HEAV), Carr. Central 506, Ate, 15491, Lima, Peru.,Emergency and Critical Care Service of the Hospital Nacional Guillermo Almenara, Jirón García Naranjo 840, La Victoria 13, Lima, Peru
| | - Lacey Lagrone
- Trauma, Acute Care Surgery, Medical Center of the Rockies, UCHealth, 2500 Rocky Mountain Ave., Suite 2200, Loveland, CO, 80538, USA
| | - Regina Ugarte Oscco
- Surgical Center of the Hospital Emergencia Ate Vitarte (HEAV), Carr. Central 506, Ate, 15491, Lima, Peru
| | - Sergio Endo Ramos
- Surgical Center of the Hospital Emergencia Ate Vitarte (HEAV), Carr. Central 506, Ate, 15491, Lima, Peru
| | - Alex Diaz Baltazar
- Surgical Center of the Hospital Emergencia Ate Vitarte (HEAV), Carr. Central 506, Ate, 15491, Lima, Peru
| | - César Vergel Cabrera
- Surgical Center of the Hospital Emergencia Ate Vitarte (HEAV), Carr. Central 506, Ate, 15491, Lima, Peru
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28
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Acevedo MJ, Steffey D, Dillon JE, Lee JT, Worhunsky DJ. Concurrent COVID-19 infection in children with acute appendicitis: A report of three cases. Radiol Case Rep 2021; 16:2972-2977. [PMID: 34221211 PMCID: PMC8236335 DOI: 10.1016/j.radcr.2021.06.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 12/28/2022] Open
Abstract
Literature describing patients with concomitant COVID-19 infection with acute appendicitis in pediatric patients is growing, and understanding the clinical picture of such patients is relevant in their treatment. We report 3 male children who were surgically treated for acute appendicitis and had concomitant SARS-CoV-2 infection. Our first patient was a 12-year-old male who presented with symptoms indicative of appendicitis but no respiratory symptoms associated with COVID-19 (eg cough, shortness of breath). Laboratory evaluation revealed leukopenia and an elevated C-reactive protein; imaging was consistent with acute appendicitis and an acute pulmonary viral infection. Though he lacked diffuse peritonitis on physical examination or a leukocytosis, he was found to have perforated appendicitis in the operating room. Our second patient was another 12-year-old male whose suspected appendicitis was confirmed via ultrasound and surgery. He tested positive for COVID-19 1 month prior and he continued to test positive for infection on admission without any associated respiratory symptoms. Our third patient was a 13-year-old patient who also presented with symptomatic acute appendicitis without apparent COVID-19 manifestations. These cases provide further examples of pediatric patients with concomitant acute appendicitis and COVID-19 infection, namely an unusual presentation of perforated appendicitis with asymptomatic COVID-19-related pulmonary infection and the more common acute appendicitis with asymptomatic COVID-19 infection.
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Affiliation(s)
- Maximo J Acevedo
- College of Medicine-NKY campus, University of Kentucky, Albright Health Center 300, 100 Grant Drive, Highland Heights, KY 41099, USA
| | - Dylan Steffey
- College of Medicine, University of Kentucky, 800 Rose Street MN 150, Lexington, KY 40506, USA
| | - Johanne E Dillon
- Department of Radiology, Division of Pediatric Radiology, University of Kentucky, Lexington, KY, USA
| | - James T Lee
- Department of Radiology, Divisions of Abdominal and Emergency Radiology, University of Kentucky, Lexington, KY, USA
| | - David J Worhunsky
- Department of Surgery, Division of Pediatric Surgery, University of Kentucky, Lexington, KY, USA
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29
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Lazzati A, Raphael Rousseau M, Bartier S, Dabi Y, Challine A, Haddad B, Herta N, Souied E, Ortala M, Epaud S, Masson M, Salaün-Penquer N, Coste A, Jung C. Impact of COVID-19 on surgical emergencies: nationwide analysis. BJS Open 2021; 5:6280342. [PMID: 34021327 PMCID: PMC8140197 DOI: 10.1093/bjsopen/zrab039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/16/2021] [Indexed: 12/21/2022] Open
Abstract
Background The COVID-19 pandemic has had a major impact on healthcare in many countries. This study assessed the effect of a nationwide lockdown in France on admissions for acute surgical conditions and the subsequent impact on postoperative mortality. Methods This was an observational analytical study, evaluating data from a national discharge database that collected all discharge reports from any hospital in France. All adult patients admitted through the emergency department and requiring a surgical treatment between 17 March and 11 May 2020, and the equivalent period in 2019 were included. The primary outcome was the change in number of hospital admissions for acute surgical conditions. Mortality was assessed in the matched population, and stratified by region. Results During the lockdown period, 57 589 consecutive patients were admitted for acute surgical conditions, representing a decrease of 20.9 per cent compared with the 2019 cohort. Significant differences between regions were observed: the decrease was 15.6, 17.2, and 26.8 per cent for low-, intermediate- and high-prevalence regions respectively. The mortality rate was 1.92 per cent during the lockdown period and 1.81 per cent in 2019. In high-prevalence zones, mortality was significantly increased (odds ratio 1.22, 95 per cent c.i. 1.06 to 1.40). Conclusion A marked decrease in hospital admissions for surgical emergencies was observed during the lockdown period, with increased mortality in regions with a higher prevalence of COVID-19 infection. Health authorities should use these findings to preserve quality of care and deliver appropriate messages to the population.
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Affiliation(s)
- A Lazzati
- Department of General and Digestive Surgery, Intercommunal Hospital of Créteil, Créteil, France.,INSERM U955, IMRB, Créteil, France
| | - M Raphael Rousseau
- Department of Medical Informatics, Intercommunal Hospital of Créteil, Créteil, France
| | - S Bartier
- INSERM U955, IMRB, Créteil, France.,University Paris-Est Creteil, School of Medicine, Créteil, France.,Department of Oto-rhino-laryngology Head and Neck Surgery, Intercommunal Hospital of Créteil, Créteil, France.,Department of Oto-rhino-laryngology Head and Neck Surgery, Paris Public Hospitals, Henri Mondor Hospital, France.,CNRS, ERL 7240, Créteil, France
| | - Y Dabi
- University Paris-Est Creteil, School of Medicine, Créteil, France.,Department of Obstetrics and Gynaecology, Intercommunal Hospital of Créteil, Créteil, France
| | - A Challine
- Department of Digestive, Hepatobiliary and Pancreatic Surgery, AP-HP, Université de Paris, Cochin Hospital, France
| | - B Haddad
- University Paris-Est Creteil, School of Medicine, Créteil, France.,Department of Obstetrics and Gynaecology, Intercommunal Hospital of Créteil, Créteil, France
| | - N Herta
- University Paris-Est Creteil, School of Medicine, Créteil, France.,Department of Ophthalmology, Intercommunal Hospital of Créteil, Créteil, France
| | - E Souied
- University Paris-Est Creteil, School of Medicine, Créteil, France.,Department of Ophthalmology, Intercommunal Hospital of Créteil, Créteil, France
| | | | - S Epaud
- Kaduceo SAS, Toulouse, France
| | | | | | - A Coste
- INSERM U955, IMRB, Créteil, France.,University Paris-Est Creteil, School of Medicine, Créteil, France.,Department of Oto-rhino-laryngology Head and Neck Surgery, Intercommunal Hospital of Créteil, Créteil, France.,Department of Oto-rhino-laryngology Head and Neck Surgery, Paris Public Hospitals, Henri Mondor Hospital, France.,CNRS, ERL 7240, Créteil, France
| | - C Jung
- Clinical Research Centre, Intercommunal Hospital of Créteil, Créteil, France
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30
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Burgard M, Cherbanyk F, Nassiopoulos K, Malekzadeh S, Pugin F, Egger B. An effect of the COVID-19 pandemic: Significantly more complicated appendicitis due to delayed presentation of patients! PLoS One 2021; 16:e0249171. [PMID: 34032800 PMCID: PMC8148360 DOI: 10.1371/journal.pone.0249171] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/12/2021] [Indexed: 12/29/2022] Open
Abstract
Aims of the study The novel coronavirus pandemic has affected emergency department consultations for surgical pathologies. The aim of our study was to compare the number of acute appendicitis cases and the proportion of complicated appendicitis before and during the COVID-19 pandemic. Methods We retrospectively analyzed all data collected from a multi-center database of patients presenting to the emergency department for acute appendicitis during the COVID-19 pandemic from March 12 to June 6, 2020, and compared these data with those from the same periods in 2017, 2018, and 2019. The number of acute appendicitis cases, proportion of complicated appendicitis, and pre- and postoperative patient characteristics were evaluated. Results A total of 306 patients were included in this evaluation. Sixty-five patients presented during the 2020 COVID-19 pandemic lockdown (group A), and 241 patients in previous years (group B: 2017–2019). The number of consultations for acute appendicitis decreased by almost 20 percent during the pandemic compared with previous periods, with a significant increase in complicated appendicitis (52% in group A versus 20% in group B, p < 0,001.). Comparing the two groups, significant differences were also noted in the duration of symptoms (symptoms > 48h in 61% and 26%, p < 0,001), the intervention time (77 vs 61 minutes, p = 0,002), length of hospital stay (hospitalization of > 2 days in 63% and 32%, p < 0.001) and duration of antibiotic treatment (antibiotics > 3 days in 36% and 24% p = 0.001). Conclusions The COVID-19 pandemic resulted in a decreased number of consultations for acute appendicitis, with a higher proportion of complicated appendicitis, most likely due to patient delay in consulting the emergency department at symptom onset. Patients and general practitioners should be aware of this problem to avoid a time delay from initial symptoms to consultation.
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Affiliation(s)
- Marie Burgard
- Department of Surgery, HFR Fribourg—Cantonal Hospital Fribourg, Villars-sur-Glâne, Switzerland
| | - Floryn Cherbanyk
- Department of Surgery, HFR Fribourg—Cantonal Hospital Fribourg, Villars-sur-Glâne, Switzerland
| | | | - Sonaz Malekzadeh
- Department of Diagnostic and Interventional Radiology, HFR Fribourg—Cantonal Hospital Fribourg, Villars-sur-Glâne, Switzerland
| | - François Pugin
- Department of Surgery, HFR Fribourg—Cantonal Hospital Fribourg, Villars-sur-Glâne, Switzerland
| | - Bernhard Egger
- Department of Surgery, HFR Fribourg—Cantonal Hospital Fribourg, Villars-sur-Glâne, Switzerland
- * E-mail:
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31
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Steffani M, Merz C, Stöß C, Landau L, Hüser N, Hartmann D, Friess H, Theisen J, Novotny A. [Effects of the first COVID-19 wave on visceral surgery : A retrospective comparison of case numbers from a university hospital and a primary care hospital]. Chirurg 2021; 92:559-566. [PMID: 34009441 PMCID: PMC8132278 DOI: 10.1007/s00104-021-01434-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2021] [Indexed: 11/07/2022]
Abstract
Hintergrund Während der ersten COVID-19-Pandemiewelle führte die Aussetzung aller elektiven Eingriffe im Zeitraum vom 15.03. bis 15.05.2020 in Deutschland zu einem Rückgang an Operationen. Die Auswirkungen auf die Zahl spezifischer Operationen in der Viszeralchirurgie sind bislang nicht bekannt. Methoden In diese retrospektive Studie wurden 301 Patienten eingeschlossen, die eine Cholezystektomie bzw. Appendektomie an einem Universitätsklinikum oder Krankenhaus der Grund- und Regelversorgung zwischen dem 15.03.2020 und 05.05.2020 (vs. 2018 und 2019) erhielten. Analysiert wurden die Fallzahlen und der klinische Verlauf. Ergebnisse Die Aussetzung des Elektivprogramms führte zu einer signifikanten Reduktion elektiver Cholezystektomien und notfallmäßiger Appendektomien. Am Universitätsklinikum reduzierte sich die Anzahl der Appendektomien von 24 im Jahr 2018 um 33 % auf 16 im Jahr 2020, die Zahl der Cholezystektomien sank von 30 um 57 % auf 13. Am Grundversorger reduzierte sich die Zahl der Appendektomiepatienten von 23 im Jahr 2018 um 48 % auf 12 im Jahr 2020, die Zahl der Cholezystektomien stieg im Jahr 2018 auf 2019 an und sank anschließend um 30 % im Jahr 2020. Die Operationsdauer, Krankenhausverweildauer und der klinische Verlauf der Patienten unterschied sich nicht signifikant zu den Vorjahreszeiträumen. Diskussion Der Lockdown während der ersten COVID-19-Pandemiewelle führte zu einer deutlichen Reduktion häufiger viszeralchirurgischer Eingriffe. Um die medizinische Versorgung der gesamten Bevölkerung während einer Pandemie möglichst auf hohem Niveau zu erhalten, müssen aktuelle Möglichkeiten der operativen und konservativen Therapie, unter anderem abhängig von lokalen Infektionszahlen und den individuellen Komorbiditäten der Patienten, gegeneinander abgewogen werden.
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Affiliation(s)
- Marcella Steffani
- Fakultät für Medizin, Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Constanze Merz
- Abteilung für Allgemein‑, Viszeral‑, Thorax- und Endokrine Chirurgie, Klinikum Landkreis Erding, Erding, Deutschland
| | - Christian Stöß
- Fakultät für Medizin, Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Lars Landau
- Abteilung für Allgemein‑, Viszeral‑, Thorax- und Endokrine Chirurgie, Klinikum Landkreis Erding, Erding, Deutschland
| | - Norbert Hüser
- Fakultät für Medizin, Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Daniel Hartmann
- Fakultät für Medizin, Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Helmut Friess
- Fakultät für Medizin, Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Jörg Theisen
- Abteilung für Allgemein‑, Viszeral‑, Thorax- und Endokrine Chirurgie, Klinikum Landkreis Erding, Erding, Deutschland
| | - Alexander Novotny
- Fakultät für Medizin, Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland.
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32
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Lee KY, Lee J, Park YY, Oh ST. Effect of the COVID-19 pandemic on surgical treatment of acute appendicitis: A single-center retrospective study. Asian J Surg 2021; 44:800-801. [PMID: 33863628 PMCID: PMC8081671 DOI: 10.1016/j.asjsur.2021.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 12/29/2022] Open
Affiliation(s)
- Kil-Yong Lee
- Division of Coloproctology, Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea
| | - Jaeim Lee
- Division of Coloproctology, Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea.
| | - Youn Young Park
- Division of Coloproctology, Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea
| | - Seong Taek Oh
- Division of Coloproctology, Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea
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Castoldi L, Solbiati M, Costantino G, Casiraghi E. Variations in volume of emergency surgeries and emergency department access at a third level hospital in Milan, Lombardy, during the COVID-19 outbreak. BMC Emerg Med 2021; 21:59. [PMID: 33971826 PMCID: PMC8107771 DOI: 10.1186/s12873-021-00445-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/08/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND During the recent outbreak of COVID-19 (coronavirus disease 2019), Lombardy was the most affected region in Italy, with 87,000 patients and 15,876 deaths up to May 26, 2020. Since February 22, 2020, well before the Government declared a state of emergency, there was a huge reduction in the number of emergency surgeries performed at hospitals in Lombardy. A general decrease in attendance at emergency departments (EDs) was also observed. The aim of our study is to report the experience of the ED of a third-level hospital in downtown Milan, Lombardy, and provide possible explanations for the observed phenomena. METHODS This retrospective, observational study assessed the volume of emergency surgeries and attendance at an ED during the course of the pandemic, i.e. immediately before, during and after a progressive community lockdown in response to the COVID-19 pandemic. These data were compared with data from the same time periods in 2019. The results are presented as means, standard error (SE), and 95% studentized confidence intervals (CI). The Wilcoxon rank signed test at a 0.05 significance level was used to assess differences in per-day ED access distributions. RESULTS Compared to 2019, a significant overall drop in emergency surgeries (60%, p < 0.002) and in ED admittance (66%, p ≅ 0) was observed in 2020. In particular, there were significant decreases in medical (40%), surgical (74%), specialist (ophthalmology, otolaryngology, traumatology, and urology) (92%), and psychiatric (60%) cases. ED admittance due to domestic violence (59%) and individuals who left the ED without being seen (76%) also decreased. Conversely, the number of deaths increased by 196%. CONCLUSIONS During the COVID-19 outbreak the volume of urgent surgeries and patients accessing our ED dropped. Currently, it is not known if mortality of people who did not seek care increased during the pandemic. Further studies are needed to understand if such reductions during the COVID-19 pandemic will result in a rebound of patients left untreated or in unwanted consequences for population health.
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Affiliation(s)
- Laura Castoldi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UOSD Chirurgia d'Urgenza,, Milano, Italy.
| | - Monica Solbiati
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UOC Pronto Soccorso e Medicina d'Urgenza, Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Giorgio Costantino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UOC Pronto Soccorso e Medicina d'Urgenza, Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Elena Casiraghi
- Anacleto Lab, Computer Science Department, Università degli Studi di Milano, Milan, Italy
- MIPS Lab, Computer Science Department, Università degli Studi di Milano, Milan, Italy
- CINI-AIIS, Italian National Laboratory in Artificial Intelligence and Intelligent Systems, University of Modena and Reggio Emilia, Modena, Italy
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Al-Masaeed M, Alghawanmeh M, Al-Singlawi A, Alsababha R, Alqudah M. An Examination of COVID-19 Medications' Effectiveness in Managing and Treating COVID-19 Patients: A Comparative Review. Healthcare (Basel) 2021; 9:557. [PMID: 34068474 PMCID: PMC8151388 DOI: 10.3390/healthcare9050557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/25/2021] [Accepted: 05/03/2021] [Indexed: 12/23/2022] Open
Abstract
Background: The review seeks to shed light on the administered and recommended COVID-19 treatment medications through an evaluation of their efficacy. Methods: Data were collected from key databases, including Scopus, Medline, Google Scholar, and CINAHL. Other platforms included WHO and FDA publications. The review's literature search was guided by the WHO solidarity clinical trials for COVID-19 scope and trial-assessment parameters. Results: The findings indicate that the use of antiretroviral drugs as an early treatment for COVID-19 patients has been useful. It has reduced hospital time, hastened the clinical cure period, delayed and reduced the need for mechanical and invasive ventilation, and reduced mortality rates. The use of vitamins, minerals, and supplements has been linked to increased immunity and thus offering the body a fighting chance. Nevertheless, antibiotics do not correlate with improving patients' wellbeing and are highly discouraged from the developed clinical trials. Conclusions: The review demonstrates the need for additional clinical trials with a randomized, extensive sample base and over a more extended period to examine the potential side effects of the medications administered. Critically, the findings underscore the need for vaccination as the only viable medication to limit the SARS-CoV-2 virus spread.
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Affiliation(s)
- Mahmoud Al-Masaeed
- Faculty of Health and Medicine, University of Newcastle, Callaghan 2308, Australia;
| | | | | | - Rawan Alsababha
- School of nursing and Midwifery, Western Sydney University, Sydney 2560, Australia;
| | - Muhammad Alqudah
- Faculty of Health and Medicine, University of Newcastle, Callaghan 2308, Australia;
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Honeyford K, Coughlan C, Nijman RG, Expert P, Burcea G, Maconochie I, Kinderlerer A, Cooke GS, Costelloe CE. Changes in Emergency Department Activity and the First COVID-19 Lockdown: A Cross-sectional Study. West J Emerg Med 2021; 22:603-607. [PMID: 34125034 PMCID: PMC8203011 DOI: 10.5811/westjem.2021.2.49614] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/13/2021] [Indexed: 12/13/2022] Open
Abstract
Introduction Emergency department (ED) attendances fell across the UK after the ‘lockdown’ introduced on 23rd March 2020 to limit the spread of coronavirus disease 2019 (COVID-19). We hypothesised that reductions would vary by patient age and disease type. We examined pre- and in-lockdown ED attendances for two COVID-19 unrelated diagnoses: one likely to be affected by lockdown measures (gastroenteritis), and one likely to be unaffected (appendicitis). Methods We conducted a retrospective cross-sectional study across two EDs in one London hospital Trust. We compared all adult and paediatric ED attendances, before (January 2020) and during lockdown (March/April 2020). Key patient demographics, method of arrival, and discharge location were compared. We used Systemised Nomenclature of Medicine codes to define attendances for gastroenteritis and appendicitis. Results ED attendances fell from 1129 per day before lockdown to 584 in lockdown, 51.7% of pre-lockdown rates. In-lockdown attendances were lowest for under-18s (16.0% of pre-lockdown). The proportion of patients admitted to hospital increased from 17.3% to 24.0%, and the proportion admitted to intensive care increased fourfold. Attendances for gastroenteritis fell from 511 to 103, 20.2% of pre-lockdown rates. Attendances for appendicitis also decreased, from 144 to 41, 28.5% of pre-lockdown rates. Conclusion ED attendances fell substantially following lockdown implementation. The biggest reduction was for under-18s. We observed reductions in attendances for gastroenteritis and appendicitis. This may reflect lower rates of infectious disease transmission, although the fall in appendicitis-related attendances suggests that behavioural factors were also important. Larger studies are urgently needed to understand changing patterns of ED use and access to emergency care during the coronavirus 2019 pandemic.
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Affiliation(s)
- Kate Honeyford
- Imperial College London, Department of Primary Care and Public Health, Global Digital Health Unit, London, United Kingdom.,Imperial Biomedical Research Centre, London, United Kingdom.,Imperial Biomedical Research Centre, London, United Kingdom
| | - Charles Coughlan
- Imperial College London, Department of Primary Care and Public Health, Global Digital Health Unit, London, United Kingdom.,Imperial College Healthcare NHS Trust, Department of Paediatrics, London, United Kingdom.,Imperial Biomedical Research Centre, London, United Kingdom
| | - Ruud G Nijman
- St. Mary's Hospital, Imperial College Healthcare NHS Trust, Department of Paediatric Emergency Medicine, London, United Kingdom.,Imperial College London, Section of Paediatric Infectious Diseases, London, United Kingdom.,Imperial Biomedical Research Centre, London, United Kingdom
| | - Paul Expert
- Imperial College London, Department of Primary Care and Public Health, Global Digital Health Unit, London, United Kingdom.,Imperial Biomedical Research Centre, London, United Kingdom.,Imperial Biomedical Research Centre, London, United Kingdom
| | - Gabriel Burcea
- Imperial College London, Department of Primary Care and Public Health, Global Digital Health Unit, London, United Kingdom.,Imperial Biomedical Research Centre, London, United Kingdom
| | - Ian Maconochie
- St. Mary's Hospital, Imperial College Healthcare NHS Trust, Department of Paediatric Emergency Medicine, London, United Kingdom.,Imperial Biomedical Research Centre, London, United Kingdom
| | - Anne Kinderlerer
- St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.,Imperial Biomedical Research Centre, London, United Kingdom
| | - Graham S Cooke
- Imperial College London, Department of Infectious Disease, London, United Kingdom.,Imperial Biomedical Research Centre, London, United Kingdom.,Imperial Biomedical Research Centre, London, United Kingdom
| | - Ceire E Costelloe
- Imperial College London, Department of Primary Care and Public Health, Global Digital Health Unit, London, United Kingdom.,Imperial Biomedical Research Centre, London, United Kingdom
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Yang Y, Li Y, Du X. Acute complex appendicitis during the COVID-19 epidemic: A single-institution retrospective analysis based on real-world data. Am J Emerg Med 2021; 46:74-77. [PMID: 33740569 PMCID: PMC7946537 DOI: 10.1016/j.ajem.2021.03.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/06/2021] [Accepted: 03/06/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives To investigate the influence of Coronavirus Disease 2019 on incidence of acute complex appendicitis and management of acute appendicitis. Methods Patients undergoing acute appendicitis surgery in a single center during the COVID-19 epidemic from January to September 2020 and patients from January to September 2019 were taken as the epidemic group and control group respectively. The clinical characteristics and surgical pathological information were compared between the two groups. The primary outcome measure was complex appendicitis. Results A total of 235 patients were included in the study, containing 106 in the epidemic group and 129 in the control group. The patients in the epidemic group had a significantly longer interval from the onset of symptoms to registration (37.92 h vs 24.57 h, P = 0.028), from registration to admission (18.69 h vs 8.04 h, P < 0.001), and from admission to surgery (7.23 h vs 6.52 h, P = 0.016). The epidemic group had a higher incidence of suppurative appendicitis (86.8% vs 76.0%, P = 0.036) and a higher incidence of complex appendicitis (35.8% vs 19.4%, P = 0.005). Conclusion Higher incidence of acute complex appendicitis seemed to occur during COVID-19 outbreak.
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Affiliation(s)
- Yu Yang
- Department of General Surgery, First Medical Center of Chinese PLA General Hospital, Beijing 100853, PR China
| | - Yuxuan Li
- Department of General Surgery, First Medical Center of Chinese PLA General Hospital, Beijing 100853, PR China
| | - Xiaohui Du
- Department of General Surgery, First Medical Center of Chinese PLA General Hospital, Beijing 100853, PR China.
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Fisher JC, Tomita SS, Ginsburg HB, Gordon A, Walker D, Kuenzler KA. Increase in Pediatric Perforated Appendicitis in the New York City Metropolitan Region at the Epicenter of the COVID-19 Outbreak. Ann Surg 2021; 273:410-415. [PMID: 32976285 PMCID: PMC7869969 DOI: 10.1097/sla.0000000000004426] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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.
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Affiliation(s)
- Jason C Fisher
- Division of Pediatric Surgery, Department of Surgery, NYU Grossman School of Medicine, Hassenfeld Children's Hospital at NYU Langone, New York, NY
- Division of Pediatric Surgery, Department of Surgery, Joseph M. Sanzari Children's Hospital, Hackensack Meridian Health, Hackensack, NJ
| | - Sandra S Tomita
- Division of Pediatric Surgery, Department of Surgery, NYU Grossman School of Medicine, Hassenfeld Children's Hospital at NYU Langone, New York, NY
- Division of Pediatric Surgery, Department of Surgery, Joseph M. Sanzari Children's Hospital, Hackensack Meridian Health, Hackensack, NJ
| | - Howard B Ginsburg
- Division of Pediatric Surgery, Department of Surgery, NYU Grossman School of Medicine, Hassenfeld Children's Hospital at NYU Langone, New York, NY
- Division of Pediatric Surgery, Department of Surgery, Joseph M. Sanzari Children's Hospital, Hackensack Meridian Health, Hackensack, NJ
| | - Alex Gordon
- Division of Pediatric Surgery, Department of Surgery, NYU Grossman School of Medicine, Hassenfeld Children's Hospital at NYU Langone, New York, NY
| | - David Walker
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
| | - Keith A Kuenzler
- Division of Pediatric Surgery, Department of Surgery, NYU Grossman School of Medicine, Hassenfeld Children's Hospital at NYU Langone, New York, NY
- Division of Pediatric Surgery, Department of Surgery, Joseph M. Sanzari Children's Hospital, Hackensack Meridian Health, Hackensack, NJ
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Wang AW, Prieto J, Ikeda DS, Lewis PR, Benzer EM, Van Gent JM. Perforated Appendicitis: An Unintended Consequence During the Coronavirus-19 Pandemic. Mil Med 2021; 186:e94-e97. [PMID: 33275655 PMCID: PMC7798865 DOI: 10.1093/milmed/usaa527] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/10/2020] [Accepted: 11/23/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has had major clinical impact across the globe. Delayed presentation for medical emergencies has been noted by the medical community. There has been limited reporting on the impact for the care for emergent surgical conditions. We sought to describe the effect of the global pandemic on the presentation and outcomes for the most common urgent general surgery disease process, acute appendicitis. METHODS We performed a retrospective review of patients admitted to the United States Naval Hospital Okinawa during the COVID-19 pandemic, from January 2020 to May 2020 (COVID cohort), and compared them to a historical cohort (pre-COVID cohort) over the prior 2 years. Demographics, clinical presentation data, and interventions were collected. RESULTS Of the 80 patients with appendicitis, 20% presented perforated. Most patients were male (71%), presented with 1 day of symptoms and had a length of stay of 1 to 2 days. Comparing groups, 13% of the pre-COVID group vs. 31% of the COVID cohort presented perforated (P = .04), with a symptom duration of 1.6 vs. 2.7 days before presentation (P = .075), respectively. CONCLUSIONS The COVID-19 pandemic and the global systematic response has impacted unrelated medical and surgical conditions. At our overseas military hospital with minimal disease burden, we observed a delay in presentation for acute appendicitis with a higher incidence of perforation. Patients should be empowered to continue to seek care for urgent and emergent medical and surgical conditions so that they are not harmed by fear of COVID-19 rather than by COVID-19 itself.
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Affiliation(s)
- Andrew W Wang
- Departmet of Surgery, United States Naval Hospital Okinawa, Okinawa, Japan, 96362
| | - James Prieto
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Daniel S Ikeda
- Departmet of Surgery, United States Naval Hospital Okinawa, Okinawa, Japan, 96362
| | - Paul R Lewis
- Departmet of Surgery, United States Naval Hospital Okinawa, Okinawa, Japan, 96362
| | - Emily M Benzer
- Departmet of Surgery, United States Naval Hospital Okinawa, Okinawa, Japan, 96362
| | - Jan-Michael Van Gent
- Departmet of Surgery, United States Naval Hospital Okinawa, Okinawa, Japan, 96362
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Willms AG, Oldhafer KJ, Conze S, Thasler WE, von Schassen C, Hauer T, Huber T, Germer CT, Günster S, Bulian DR, Hirche Z, Filser J, Stavrou GA, Reichert M, Malkomes P, Seyfried S, Ludwig T, Hillebrecht HC, Pantelis D, Brunner S, Rost W, Lock JF. Appendicitis during the COVID-19 lockdown: results of a multicenter analysis in Germany. Langenbecks Arch Surg 2021; 406:367-375. [PMID: 33550453 PMCID: PMC7867500 DOI: 10.1007/s00423-021-02090-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/12/2021] [Indexed: 12/22/2022]
Abstract
Purpose The COVID-19 pandemic has transformed medical care worldwide. General surgery has been affected in elective procedures, yet the implications for emergency surgery are unclear. The current study analyzes the effect of the COVID-19 lockdown in spring 2020 on appendicitis treatment in Germany. Methods Hospitals that provided emergency surgical care during the COVID-19 lockdown were invited to participate. All patients diagnosed with appendicitis during the lockdown period (10 weeks) and, as a comparison group, patients from the same period in 2019 were analyzed. Clinical and laboratory parameters, intraoperative and pathological findings, and postoperative outcomes were analyzed. Results A total of 1915 appendectomies from 41 surgical departments in Germany were included. Compared to 2019 the number of appendectomies decreased by 13.5% (1.027 to 888, p=0.003) during the first 2020 COVID-19 lockdown. The delay between the onset of symptoms and medical consultation was substantially longer in the COVID-19 risk group and for the elderly. The rate of complicated appendicitis increased (58.2 to 64.4%), while the absolute number of complicated appendicitis decreased from 597 to 569, (p=0.012). The rate of negative appendectomies decreased significantly (6.7 to 4.6%; p=0.012). Overall postoperative morbidity and mortality, however, did not change. Conclusion The COVID-19 lockdown had significant effects on abdominal emergency surgery in Germany. These seem to result from a stricter selection and a longer waiting time between the onset of symptoms and medical consultation for risk patients. However, the standard of emergency surgical care in Germany was maintained. Supplementary Information The online version contains supplementary material available at 10.1007/s00423-021-02090-3.
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Affiliation(s)
- Arnulf G Willms
- Klinik für Allgemein- und Viszeralchirurgie, Thoraxchirurgie, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Germany.
| | - Karl J Oldhafer
- Klinik für Leber-, Gallenwegs- und Pankreaschirurgie, Asklepios Klinik Barmbeck, Hamburg, Germany
| | - Sophie Conze
- Klinik für Allgemein- und Viszeralchirurgie, Thoraxchirurgie, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Germany
| | - Wolfgang E Thasler
- Abteilung für Allgemein-, Viszeral-, Thorax- und Minimalinvasive Chirurgie, Rot-Kreuz-Klinikum München, München, Germany
| | - Christian von Schassen
- Klinik für Allgemein- Viszeral- und Thoraxchirurgie, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany
| | - Thorsten Hauer
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrkrankenhaus Berlin, Berlin, Germany
| | - Tobias Huber
- Klinik für Allgemein-, Viszeral-und Transplantationschirurgie, Universitätsmedizin Mainz, Mainz, Germany
| | - Christoph-Thomas Germer
- Klinik und Poliklinik für Allgemein-, Viszeral-, Transplantations-, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Simone Günster
- Operatives Zentrum für Allgemeinchirurgie, Klinikum Fürth, Fürth, Germany
| | - Dirk R Bulian
- Klinik für Viszeral-, Tumor-, Transplantations- und Gefäßchirurgie, Kliniken der Stadt Köln, Standorte Merheim und Holweide, Köln, Germany
| | - Zarah Hirche
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Klinikum Ludwigshafen am Rhein, Ludwigshafen, Germany
| | - Jörg Filser
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, InnKlinikum Altötting und Mühldorf, Altötting, Germany
| | - Gregor A Stavrou
- Klinik für Allgemein- und Viszeralchirurgie, Thoraxchirurgie, Chirurgische Onkologie, Klinikum Saarbrücken, Saarbrücken, Germany
| | - Martin Reichert
- Klinik für Allgemein-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen, Gießen, Germany
| | - Patrizia Malkomes
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Steffen Seyfried
- Chirurgische Klinik, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Tobias Ludwig
- Abteilung für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsmedizin Rostock, Rostock, Germany
| | - Hans C Hillebrecht
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Dimitrios Pantelis
- Abteilung für Allgemein- und Viszeralchirurgie, GFO Kliniken Bonn, Bonn, Germany
| | - Stefanie Brunner
- Klinik und Poliklinik für Allgemein-, Viszeral-, Tumor- und Transplantationschirurgie, Uniklinik Köln, Köln, Germany
| | - Wilm Rost
- Klinik für Allgemein- Viszeral- und Thoraxchirurgie, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany
| | - Johan F Lock
- Klinik und Poliklinik für Allgemein-, Viszeral-, Transplantations-, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Würzburg, Germany
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Wright EV, Musbahi O, Singh A, Somashekar N, Huber CP, Wiik AV. Increased perioperative mortality for femoral neck fractures in patients with coronavirus disease 2019 (COVID-19): experience from the United Kingdom during the first wave of the pandemic. Patient Saf Surg 2021; 15:8. [PMID: 33423685 PMCID: PMC7797178 DOI: 10.1186/s13037-020-00279-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/08/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The coronavirus disease 19 (COVID-19) pandemic has presented modern healthcare with an unprecedented challenge. At the peak of the pandemic, trauma and orthopaedic services at our institutions undertook internal restructuring, diverting resources to frontline medical care. Consequently, we sought to assess the impact on the elderly and comorbid patients presenting with femoral neck fractures, with a particular focus on 30-day mortality, length of stay, multidisciplinary team involvement and departmental structuring. METHOD A retrospective analysis of patients presenting with femoral neck fractures at three separate West London NHS Trusts was undertaken between March 11, 2020, to April 30, 2020. Length of stay, 30-day mortality and adherence to parameters constituting the best care evidence-based practice tariffs were compared between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive and negative patients. A similar comparison was also conducted between our cohort and the equivalent period in 2018 using data from the National Hip Fracture Database. RESULTS A total of 68 patients presenting with femoral neck fractures were identified, mean age 81 (range 38-98), 73% female. There were 10 confirmed/suspected cases of COVID-19 on admission and a further seven confirmed as inpatients. The 30-day mortality within our cohort was 11.76% compared to 6% nationally in 2018 (p = 0.045). Orthogeriatric reviews occurred within 72 h in 71% of cases compared to 88% in the equivalent 2018 period. Within the cohort, mean length of stay was 17.13 days (SD 5.6, range 8-27 days) for SARS-CoV-2 positive patients compared to 10 days (SD 8.7, range 1-53 days) for negative patients (p < 0.05). Thirty-two patients (47%) required increased packages of care on discharge or rehabilitation. CONCLUSIONS The increase in 30-day mortality for SARS-CoV-2 positive patients presenting with femoral neck fractures is multifactorial, resulting from a combination of the direct effects of COVID-19 pneumonia as well as changes to the delivery of orthopaedic services. The provision of multidisciplinary care was directly affected by staff redeployment, particularly reorganisation of orthogeriatric services and lack of continuity of ward based clinical care. Our experiences have re-directed efforts towards the management of theatre teams, patient services and staffing, should we be faced with either a resurgence of COVID-19 or a future pandemic.
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Affiliation(s)
- Esther Victoria Wright
- The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK.,Imperial College London, London, UK
| | - Omar Musbahi
- Imperial College London, London, UK. .,West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Middlesex, UK.
| | - Abhinav Singh
- Northwick Park Hospital NHS Foundation Trust, Harrow, UK
| | | | - Christopher P Huber
- West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Middlesex, UK
| | - Anatole Vilhelm Wiik
- Imperial College London, London, UK.,West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Middlesex, UK
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Patel VK, Ye K, In H, Scheinfeld MH. Non-operative Management for Acute Appendicitis During the COVID-19 Pandemic Does Not Increase the Rate of Complications. J Gastrointest Surg 2021; 25:1327-9. [PMID: 33140319 DOI: 10.1007/s11605-020-04844-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/17/2020] [Indexed: 01/31/2023]
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Schäfer FM, Meyer J, Kellnar S, Warmbrunn J, Schuster T, Simon S, Meyer T, Platzer J, Hubertus J, Seitz ST, Knorr C, Stehr M. Increased Incidence of Perforated Appendicitis in Children During COVID-19 Pandemic in a Bavarian Multi-Center Study. Front Pediatr 2021; 9:683607. [PMID: 34026695 PMCID: PMC8138624 DOI: 10.3389/fped.2021.683607] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 04/12/2021] [Indexed: 12/29/2022] Open
Abstract
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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Affiliation(s)
- Frank-Mattias Schäfer
- Department of Pediatric Surgery and Pediatric Urology, Cnopfsche Kinderklinik, Nuremberg, Germany
| | - Johannes Meyer
- Department of Pediatric Surgery and Pediatric Urology, Cnopfsche Kinderklinik, Nuremberg, Germany
| | - Stephan Kellnar
- Department of Pediatric Surgery, Klinikum Dritter Orden, Munich, Germany
| | - Jakob Warmbrunn
- Department of Pediatric Surgery, Klinikum Schwabing, Technical University Munich, Munich, Germany
| | - Tobias Schuster
- Department of Pediatric Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Stefanie Simon
- Department of Pediatric Surgery and Pediatric Urology, Klinikum Nürnberg, Nuremberg, Germany
| | - Thomas Meyer
- Department of Pediatric Surgery, Pediatric Urology and Pediatric Trauma, Hospital for General, Visceral, Vascular and Pediatric Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Julia Platzer
- Center for Pediatric and Adolescent Medicine, Children's Hospital St. Marien gGmbH, Landshut, Germany
| | - Jochen Hubertus
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, University Hospital Munich, Munich, Germany
| | - Sigurd T Seitz
- Department of Pediatric Surgery, University Hospital, Friedrich-Alexander-Universität (FAU) Erlangen, Erlangen, Germany
| | - Christian Knorr
- Department of Pediatric Surgery and Pediatric Orthopedics, Barmherzige Brüder Hospital - St. Hedwig Regensburg, Regensburg, Germany
| | - Maximilian Stehr
- Department of Pediatric Surgery and Pediatric Urology, Cnopfsche Kinderklinik, Nuremberg, Germany
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Zvizdic Z, Vranic S. Decreased number of acute appendicitis cases in pediatric population during the COVID-19 pandemic: Any link? J Pediatr Surg 2021; 56:199-200. [PMID: 32943199 PMCID: PMC7441018 DOI: 10.1016/j.jpedsurg.2020.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/12/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Zlatan Zvizdic
- Department of Pediatric Surgery, Clinical Center, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Semir Vranic
- College of Medicine, QU Health, Qatar University, Doha, Qatar.
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Tuech JJ, Schwarz L, Pocard M. [RE: Strategy for the practice of digestive and oncologic surgery in COVID-19 epidemic situation]. ACTA ACUST UNITED AC 2020; 158:101-102. [PMID: 33250944 PMCID: PMC7678451 DOI: 10.1016/j.jchirv.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- J-J Tuech
- Rouen university hospital, department of digestive surgery, 1, rue de Germont, 76031 Rouen cedex, France.,Normandie university, UNIROUEN, UMR 1245 Inserm, Rouen university Hospital, Department of genomic and personalized medicine in cancer and neurological Disorders, 76000 Rouen, France.,Université de Paris, UMR 1275 CAP Paris-Tech, 75010 Paris, France
| | - L Schwarz
- Rouen university hospital, department of digestive surgery, 1, rue de Germont, 76031 Rouen cedex, France.,Normandie university, UNIROUEN, UMR 1245 Inserm, Rouen university Hospital, Department of genomic and personalized medicine in cancer and neurological Disorders, 76000 Rouen, France.,Université de Paris, UMR 1275 CAP Paris-Tech, 75010 Paris, France
| | - M Pocard
- Service de chirurgie digestive et cancérologique Hôpital Lariboisière, 2, rue Ambroise Paré, 75010 Paris, France
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Montalva L, Haffreingue A, Ali L, Clariot S, Julien-Marsollier F, Ghoneimi AE, Peycelon M, Bonnard A. The role of a pediatric tertiary care center in avoiding collateral damage for children with acute appendicitis during the COVID-19 outbreak. Pediatr Surg Int 2020; 36:1397-1405. [PMID: 33070203 PMCID: PMC7568762 DOI: 10.1007/s00383-020-04759-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the impact of the COVID-19 pandemic-related lockdown on management and outcomes of children with acute appendicitis. METHODS A retrospective cohort study was conducted, including children treated for acute appendicitis (January 20th-May 11th, 2020). The data regarding the severity of appendicitis and outcome were collected and compared for two time periods, before and after the nationwide lockdown (March 17th, 2020). RESULTS The number of cases of acute appendicitis increased by 77% during the lockdown (n = 39 vs. n = 69, p = 0.03). During the lockdown, children treated for appendicitis were older (11.1 vs. 8.9 years, p = 0.003), and were more likely to live more than 5 km away from our institution (77% vs. 52%, p = 0.017). Less children had previously consulted a general practitioner (15% vs. 33%, p = 0.028), whereas more children were transferred from other hospitals (52% vs. 31%, p = 0.043). There was no difference in terms of length of hospital stay, rate of postoperative intra-abdominal abscess, ER visits, and readmissions between both periods. Three children (4%) were diagnosed with COVID-19 and appendicitis. CONCLUSIONS Despite an increase in the number of children with appendicitis managed at our hospital during the COVID-19-related lockdown, management, and outcome remained similar. Although our pediatric center was strongly affected by this pandemic, maintaining our prior practice strategies for acute appendicitis avoided the occurrence of collateral damage for those children.
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Affiliation(s)
- Louise Montalva
- Department of General Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 48 boulevard Sérurier, 75019 Paris, France
| | - Aurore Haffreingue
- Department of General Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 48 boulevard Sérurier, 75019 Paris, France
| | - Liza Ali
- Department of General Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 48 boulevard Sérurier, 75019 Paris, France
| | - Simon Clariot
- Department of Anesthesia and Intensive Care, Henri-Mondor University Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Créteil, France
| | - Florence Julien-Marsollier
- Department of Anesthesia and Intensive Care, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Alaa El Ghoneimi
- Department of General Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 48 boulevard Sérurier, 75019 Paris, France ,University of Paris, Paris, France
| | - Matthieu Peycelon
- Department of General Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 48 boulevard Sérurier, 75019 Paris, France ,University of Paris, Paris, France
| | - Arnaud Bonnard
- Department of General Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), 48 boulevard Sérurier, 75019 Paris, France ,University of Paris, Paris, France
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English W, Habib Bedwani N, Smith C, Doganay E, Marsden M, Muse S, Mak WK, Chana M, Eves J, Shatkar V. Suspected appendicitis and COVID-19, a change in investigation and management-a multicentre cohort study. Langenbecks Arch Surg 2020; 406:357-365. [PMID: 33169297 PMCID: PMC7652586 DOI: 10.1007/s00423-020-02023-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/02/2020] [Indexed: 12/14/2022]
Abstract
Purpose The COVID-19 pandemic has reformed global healthcare delivery. On 25 March 2020, Intercollegiate guidelines were published in the UK to promote safe surgical provision during the COVID-19 outbreak advocating non-operative management or avoidance of laparoscopy when surgery is essential. The effects of this on the investigation and management of appendicitis remain unknown. Methods We performed a multicentre, prospective, observational study from the start of the new guidelines to the 6th of May 2020. We included all patients referred to surgical teams with suspected appendicitis. A recent historical cohort was identified for comparison. The primary outcome was the impact of the COVID-19 pandemic on the use of non-operative management in appendicitis. Secondary outcomes included imaging, negative appendicectomy rate (NAR), length of stay (LOS) and 30-day complications. Results A total of 63/164 (38%) patients compared to 79/191 (41%) were diagnosed with appendicitis before and after the guidelines were introduced (p = 0.589). CT scanning increased (71/164 vs 105/191; p = 0.033) while ultrasound scanning decreased (71/164 vs 62/191; p = 0.037). Appendicitis was more likely to be managed non-operatively (11/63 vs 51/79; p < 0.001) and, of those managed surgically, with an open approach (3/52 vs 26/28 p < 0.001). The NAR also reduced (5/52 vs 0/28; p = 0.157). LOS was shorter in non-operatively managed patients (1 day vs 3 days; p < 0.001) without a difference in complications (10/51 vs 4/28; p = 0.760). Conclusion Introduction of the guidelines was associated with changes in practice. Despite these changes, short-term complications did not increase and LOS decreased. Questions remain on the longer-term complication rates in non-operatively managed patients. Supplementary Information The online version contains supplementary material available at 10.1007/s00423-020-02023-6.
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Affiliation(s)
- W English
- Department of General Surgery, Queens Hospital, BHR NHS Trust, London, UK. .,National Bowel Research Centre, Blizard Institute, QMUL, London, UK.
| | - N Habib Bedwani
- Department of General Surgery, Queens Hospital, BHR NHS Trust, London, UK
| | - C Smith
- Department of General Surgery, Queens Hospital, BHR NHS Trust, London, UK
| | - E Doganay
- Department of General Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - M Marsden
- Department of General Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - S Muse
- Department of General Surgery, The Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK
| | - W K Mak
- Department of General Surgery, The Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK
| | - M Chana
- Department of General Surgery, The Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK
| | - J Eves
- Department of General Surgery, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - V Shatkar
- Department of General Surgery, Queens Hospital, BHR NHS Trust, London, UK
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Abstract
BACKGROUND The global crisis resulting from the coronavirus pandemic has imposed a large burden on health systems worldwide. Nonetheless, acute abdominal surgical emergencies are major causes for nontrauma-related hospital admissions and their incidences were expected to remain unchanged. Surprisingly, a significant decrease in volume and a higher proportion of complicated cases are being observed worldwide. METHODS The present study assesses the local impact of the coronavirus pandemic on the emergency presentation of acute appendicitis in a Brazilian hospital. A retrospective analysis was conducted on patients undergoing emergency surgery for the clinically suspected diagnosis of acute appendicitis during the 2-month period of March and April 2020 and the same time interval in the previous year. Data on demographics, timing of symptom onset and hospital presentation, intraoperative details, postoperative complications, hospital length of stay, and histological examination of the specimen were retrieved from individual registries. RESULTS The number of appendectomies during the pandemic was 36, which represents a 56% reduction compared to the 82 patients operated during the same period in 2019. The average time of symptom onset to hospital arrival was significantly higher in 2020 (40.6 vs. 28.2 hours, P = .02). The classification of appendicitis revealed a significant higher proportion of complicated cases than the previous year (33.3% vs. 15.2%, P = .04). The rate of postoperative complications and the average length of stay were not statistically different between the groups. CONCLUSION Further assessment of patients' concerns and systematic monitoring of emergency presentations are expected to help us understand and adequately address this issue.
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Affiliation(s)
| | - Eduardo N. Trindade
- institution-id-type="Ringgold" />Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Omero P. Costa Filho
- institution-id-type="Ringgold" />Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Miguel P. Nácul
- institution-id-type="Ringgold" />Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Artur P. Seabra
- institution-id-type="Ringgold" />Hospital Moinhos de Vento, Porto Alegre, Brazil
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49
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Zhou Y, Cen LS. Managing acute appendicitis during the COVID-19 pandemic in Jiaxing, China. World J Clin Cases 2020; 8:4349-4359. [PMID: 33083394 PMCID: PMC7559659 DOI: 10.12998/wjcc.v8.i19.4349] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/05/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 19 (COVID-19) is a global pandemic and has had a profound impact on our routine surgical activities. Acute appendicitis is the most common abdominal emergency worldwide. Therefore, it is highly essential to assess the influence the pandemic has on acute appendicitis.
AIM To assess the efficacy of the management of acute appendicitis during the COVID-19 pandemic.
METHODS We retrospectively analyzed 90 patients who presented with acute appendicitis during the outbreak of COVID-19 in Jiaxing, China. Clinical data regarding appendectomies patients were also collected for the corresponding time frame from 2019. Preoperative management, intraoperative protective measures, and postoperative management were conducted.
RESULTS After screening, six patients were identified as unqualified due to fever and were then referred to the COVID-19 expert group. The results of the nucleic acid test were negative. Of the 76 patients enrolled in the simple group, nine patients received medication therapy, and all others underwent surgery. From this same group, 66 patients were diagnosed with suppurative appendicitis, and one patient was diagnosed with perforated appendicitis after surgery. There were 14 patients in the complex group, for which the postoperative diagnosis indicated perforated appendicitis. The proportion of men with perforated appendicitis was higher than that in 2019 (P < 0.05). The chief complaint duration for perforated appendicitis patients in 2020 was longer than that in 2019 (P < 0.05). The routine blood test showed that white blood cell counts and neutrophil ratios were higher in perforated appendicitis patients in 2020 than in 2019 (P < 0.05). The ratio of open appendectomies to the amount of mean blood loss during surgery was greater in 2020 than in 2019 (P < 0.05). Online consultation after discharge was selected in 59 cases (65.6%). No perioperative infection with COVID-19 or long-term postoperative complications were found.
CONCLUSION The management of acute appendicitis from Jiaxing effectively reduced the influence of the pandemic and minimized the risk of nosocomial infection.
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Affiliation(s)
- Yuan Zhou
- Department of Gastrointestinal Surgery, The First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University, Jiaxing 31400, Zhejiang Province, China
| | - Lu-Sha Cen
- Department of Ophthalmology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
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Verma S, Garg P, Verma A, Sirohi V. Careful Non-operative Management with Surveillance of Acute Appendicitis During COVID-19 Pandemic. Indian J Surg 2020; 83:388-389. [PMID: 33041565 PMCID: PMC7533153 DOI: 10.1007/s12262-020-02620-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/29/2020] [Indexed: 12/29/2022] Open
Affiliation(s)
| | - Pradeep Garg
- Department of General Surgery, PGIMS, Rohtak, India
| | | | - Vivek Sirohi
- Department of General Surgery, PGIMS, Rohtak, India
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