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Maneck M, Günster C, Meyer HJ, Heidecke CD, Rolle U. Influence of COVID-19 confinement measures on appendectomies in Germany-a claims data analysis of 9797 patients. Langenbecks Arch Surg 2020; 406:385-391. [PMID: 33277682 PMCID: PMC7717103 DOI: 10.1007/s00423-020-02041-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/17/2020] [Indexed: 11/28/2022]
Abstract
Purpose COVID-19 pandemic had multiple influences on the social, industrial, and medical situation in all affected countries. Measures of obligatory medical confinement were suspensions of scheduled non-emergent surgical procedures and outpatients’ clinics as well as overall access restrictions to hospitals and medical practices. The aim of this retrospective study was to assess if the obligatory confinement (lockdown) had an effect on the number of appendectomies (during and after the period of lockdown). Methods This retrospective study was based on anonymized nationwide administrative claims data of the German Local General Sickness Fund (AOK). Patients admitted for diseases of the appendix (ICD-10: K35-K38) or abdominal and pelvic pain (ICD-10: R10) who underwent an appendectomy (OPS: 5-470) were included. The study period included 6 weeks of German lockdown (16 March–26 April 2020) as well as 6 weeks before (03 February–15 March 2020) and after (27 April–07 June 2020). These periods were compared to the respective one in 2018 and 2019. Results The overall number of appendectomies was significantly reduced during the lockdown time in 2020 compared to that in 2018 and 2019. This decrease affects only appendectomies due to acute simple (ICD-10: K35.30, K35.8) and non-acute appendicitis (ICD-10: K36-K38, R10). Numbers for appendectomies in acute complex appendicitis remained unchanged. Female patients and in the age group 1–18 years showed the strongest decrease in number of cases. Conclusion The lockdown in Germany resulted in a decreased number of appendectomies. This affected mainly appendectomies in simple acute and non-acute appendicitis, but not complicated acute appendicitis. The study gives no evidence that the confinement measures resulted in a deterioration of medical care for appendicitis.
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Affiliation(s)
| | | | | | - Claus-Dieter Heidecke
- Department of General, Visceral, Thoracic and Vascular Surgery, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Udo Rolle
- Goethe-University Frankfurt, University Hospital, Department of Paediatric Surgery and Paediatric Urology, Frankfurt, Germany.
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102
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Neufeld MY, Bauerle W, Eriksson E, Azar FK, Evans HL, Johnson M, Lawless RA, Lottenberg L, Sanchez SE, Simianu VV, Thomas CS, Drake FT. Where did the patients go? Changes in acute appendicitis presentation and severity of illness during the coronavirus disease 2019 pandemic: A retrospective cohort study. Surgery 2020; 169:808-815. [PMID: 33288212 PMCID: PMC7717883 DOI: 10.1016/j.surg.2020.10.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/16/2020] [Accepted: 10/28/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND The coronavirus disease 2019 pandemic restricted movement of individuals and altered provision of health care, abruptly transforming health care-use behaviors. It serves as a natural experiment to explore changes in presentations for surgical diseases including acute appendicitis. The objective was to determine if the pandemic was associated with changes in incidence of acute appendicitis compared to a historical control and to determine if there were associated changes in disease severity. METHODS The study is a retrospective, multicenter cohort study of adults (N = 956) presenting with appendicitis in nonpandemic versus pandemic time periods (December 1, 2019-March 10, 2020 versus March 11, 2020-May 16, 2020). Corresponding time periods in 2018 and 2019 composed the historical control. Primary outcome was mean biweekly counts of all appendicitis presentations, then stratified by complicated (n = 209) and uncomplicated (n = 747) disease. Trends in presentations were compared using difference-in-differences methodology. Changes in odds of presenting with complicated disease were assessed via clustered multivariable logistic regression. RESULTS There was a 29% decrease in mean biweekly appendicitis presentations from 5.4 to 3.8 (rate ratio = 0.71 [0.51, 0.98]) after the pandemic declaration, with a significant difference in differences compared with historical control (P = .003). Stratified by severity, the decrease was significant for uncomplicated appendicitis (rate ratio = 0.65 [95% confidence interval 0.47-0.91]) when compared with historical control (P = .03) but not for complicated appendicitis (rate ratio = 0.89 [95% confidence interval 0.52-1.52]); (P = .49). The odds of presenting with complicated disease did not change (adjusted odds ratio 1.36 [95% confidence interval 0.83-2.25]). CONCLUSION The pandemic was associated with decreased incidence of uncomplicated appendicitis without an accompanying increase in complicated disease. Changes in individual health care-use behaviors may underlie these differences, suggesting that some cases of uncomplicated appendicitis may resolve without progression to complicated disease.
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Affiliation(s)
- Miriam Y Neufeld
- Department of Surgery, Boston Medical Center/Boston University School of Medicine, MA.
| | - Wayne Bauerle
- Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Evert Eriksson
- Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Faris K Azar
- Department of Surgery, St Mary's Medical Center, West Palm Beach, FL; Department of Surgery, Florida Atlantic University, Boca Raton, FL
| | - Heather L Evans
- Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Meredith Johnson
- Department of Surgery, Virginia Mason Medical Center, Seattle, WA
| | | | - Lawrence Lottenberg
- Department of Surgery, St Mary's Medical Center, West Palm Beach, FL; Department of Surgery, Florida Atlantic University, Boca Raton, FL
| | - Sabrina E Sanchez
- Department of Surgery, Boston Medical Center/Boston University School of Medicine, MA
| | - Vlad V Simianu
- Department of Surgery, Virginia Mason Medical Center, Seattle, WA
| | | | - F Thurston Drake
- Department of Surgery, Boston Medical Center/Boston University School of Medicine, MA
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103
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Kvasnovsky CL, Shi Y, Rich BS, Glick RD, Soffer SZ, Lipskar AM, Dolgin S, Bagrodia N, Hong A, Prince JM, James DE, Sathya C. Reply to letter to the editor. J Pediatr Surg 2020; 55:2846. [PMID: 32972744 PMCID: PMC7421302 DOI: 10.1016/j.jpedsurg.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Charlotte L Kvasnovsky
- Cohen Children's Medical Center, Division of Pediatric Surgery, 269-01 76th Avenue, New Hyde Park, NY 11040.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.
| | - Yan Shi
- Cohen Children's Medical Center, Division of Pediatric Surgery, 269-01 76th Avenue, New Hyde Park, NY 11040.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Barrie S Rich
- Cohen Children's Medical Center, Division of Pediatric Surgery, 269-01 76th Avenue, New Hyde Park, NY 11040.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Richard D Glick
- Cohen Children's Medical Center, Division of Pediatric Surgery, 269-01 76th Avenue, New Hyde Park, NY 11040.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Samuel Z Soffer
- Cohen Children's Medical Center, Division of Pediatric Surgery, 269-01 76th Avenue, New Hyde Park, NY 11040.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Aaron M Lipskar
- Cohen Children's Medical Center, Division of Pediatric Surgery, 269-01 76th Avenue, New Hyde Park, NY 11040.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Stephen Dolgin
- Cohen Children's Medical Center, Division of Pediatric Surgery, 269-01 76th Avenue, New Hyde Park, NY 11040.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Naina Bagrodia
- Cohen Children's Medical Center, Division of Pediatric Surgery, 269-01 76th Avenue, New Hyde Park, NY 11040.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Andrew Hong
- Cohen Children's Medical Center, Division of Pediatric Surgery, 269-01 76th Avenue, New Hyde Park, NY 11040.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Jose M Prince
- Cohen Children's Medical Center, Division of Pediatric Surgery, 269-01 76th Avenue, New Hyde Park, NY 11040.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Douglas E James
- Cohen Children's Medical Center, Division of Pediatric Surgery, 269-01 76th Avenue, New Hyde Park, NY 11040.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Chethan Sathya
- Cohen Children's Medical Center, Division of Pediatric Surgery, 269-01 76th Avenue, New Hyde Park, NY 11040.; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
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104
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Navarro F, Jarry C, Gabrielli M. Afterthoughts from an Unexpected Morbidity under COVID-19 pandemic. J INVEST SURG 2020; 35:411-412. [PMID: 33164621 DOI: 10.1080/08941939.2020.1843206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Francisco Navarro
- Department of Digestive Surgery, Clinic Hospital, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristian Jarry
- Department of Digestive Surgery, Clinic Hospital, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mauricio Gabrielli
- Department of Digestive Surgery, Clinic Hospital, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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105
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Kumaira Fonseca M, Trindade EN, Costa Filho OP, Nácul MP, Seabra AP. Impact of COVID-19 Outbreak on the Emergency Presentation of Acute Appendicitis. Am Surg 2020; 86:1508-1512. [PMID: 33156694 PMCID: PMC8685472 DOI: 10.1177/0003134820972098] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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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106
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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] [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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107
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Perl L, Ben Avraham B, Vaknin-Assa H, Ben Gal T, Kornowski R. A rise in left atrial pressure detected by the V-LAP™ system for patients with heart failure during the coronavirus disease 2019 pandemic. ESC Heart Fail 2020; 7:4361-4366. [PMID: 32965779 PMCID: PMC7537224 DOI: 10.1002/ehf2.13033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/22/2020] [Accepted: 09/09/2020] [Indexed: 01/16/2023] Open
Abstract
During the coronavirus disease 2019 (COVID‐19) pandemic, many patients refrained from inpatient medical care. For those inflicted with heart failure (HF), the risk of repeat hospitalizations is particularly high in case of infection. This presents an important opportunity for remote monitoring of haemodynamic data for these patients, in order to detect and treat accordingly. The aim of the present case is to report of the first measurements of a novel wireless left atrial pressure (LAP) monitoring system, the V‐LAP™ (Vectorious Medical Technologies, Ltd), during the COVID‐19 pandemic. The V‐LAP™ Left Atrium Monitoring systEm for Patients With Chronic sysTOlic & Diastolic Congestive heart Failure (VECTOR‐HF) is a first‐in‐man clinical study assessing the safety and feasibility of the V‐LAP™ monitoring system. Our first patient, a 59‐year‐old man with severe ischaemic cardiomyopathy (left ventricular ejection fraction −30%) was enrolled prior to the COVID‐19 outbreak. As per protocol, both the patient and the medical team were blinded to the results in the first 3 months after implantation. We were able to witness the LAP during the pandemic, as the patient remained undertreated, demonstrating a gradual increase from a mean pressure of 6.56 to 19.4 mmHg, as well as prominent V waves, before the data became available to the medical team and the patient was treated accordingly. Thereafter, pressures have returned to low values. This case demonstrated the feasibility of remote monitoring of LAP using the V‐LAP™ system, as well as the potential benefit of remote care of HF patients.
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Affiliation(s)
- Leor Perl
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Binyamin Ben Avraham
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hana Vaknin-Assa
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tuvia Ben Gal
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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108
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La Pergola E, Sgrò A, Rebosio F, Vavassori D, Fava G, Codrich D, Montanaro B, Leva E, Schleef J, Cheli M, Pelizzo G, Gamba P, Alberti D, Betalli P. Appendicitis in Children in a Large Italian COVID-19 Pandemic Area. Front Pediatr 2020; 8:600320. [PMID: 33363065 PMCID: PMC7755995 DOI: 10.3389/fped.2020.600320] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 11/09/2020] [Indexed: 12/26/2022] Open
Abstract
Introduction: The coronavirus disease 2019 (COVID-19) pandemic has dramatically changed the routine activities of pediatric surgical centers, and it determined the reduction of admissions in the pediatric emergency departments (PED). We reviewed the records of patients affected by acute appendicitis (AA) during the COVID-19 pandemic period in a large Italian COVID-19 pandemic area. Methods: Data regarding demographics, age, macroscopic and microscopic findings, and time between symptom onset and PED admission of patients affected by confirmed AA in the period between March and April 2020 were considered. The data were compared with those obtained during the same period of 2019, 2018, and 2017 in the included centers. Data were quoted as median (range) or absolute number. Non-parametric statistical tests were used to compare groups. A p ≤ 0.05 was regarded as significant. Since only anonymous data have been used and the data storage meets current data protection regulations, ethical committee approval was not required for this study. Results: Eighty-six patients underwent surgical appendectomy for AA between February 20th, 2020 and April 20th, 2020; 32.5% were complicated appendicitis and 67.5% were uncomplicated. Fifty-three patients were males and 33 were females. Patients' age ranged from 3 to 17 years and the median age was 10 years. The median time between the onset of symptoms and the admission in PED was 1.85 days. The average time between the symptom onset and PED admission was 1.8 days. Conclusions: Although fear from the COVID-19 pandemic determined a delayed diagnosis of serious pediatric diseases, the increasing prevalence and severity of AA were not demonstrated in the most COVID-19-affected areas of Italy.
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Affiliation(s)
- Enrico La Pergola
- Paediatric Surgery Unit, Ospedale dei Bambini V. Buzzi, Milan, Italy
| | - Alberto Sgrò
- Paediatric Surgery Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Federico Rebosio
- Paediatric Surgery Unit, Ospedale dei Bambini V. Buzzi, Milan, Italy.,Department of Paediatric Surgery, "Spedali Civili" Children's Hospital, Brescia, Italy
| | - Daniele Vavassori
- Department of Paediatric Surgery, Papa Giovanni XXIII, Bergamo, Italy
| | - Giorgio Fava
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Codrich
- Department of Paediatric Surgery, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Beatrice Montanaro
- Department of Paediatric Surgery, "Spedali Civili" Children's Hospital, Brescia, Italy
| | - Ernesto Leva
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Jurgen Schleef
- Department of Paediatric Surgery, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - M Cheli
- Department of Paediatric Surgery, Papa Giovanni XXIII, Bergamo, Italy
| | - Gloria Pelizzo
- Paediatric Surgery Unit, Ospedale dei Bambini V. Buzzi, Milan, Italy
| | - Piergiorgio Gamba
- Paediatric Surgery Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Daniele Alberti
- Department of Paediatric Surgery, "Spedali Civili" Children's Hospital, Brescia, Italy
| | - Pietro Betalli
- Department of Paediatric Surgery, Papa Giovanni XXIII, Bergamo, Italy
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